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The Gale Encyclopedia of Alternative Medicine, Second Edition 

Project Editor 

Jacqueline L. Longe 


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The Gale encyclopedia of alternative medicine / Jacqueline L. Longe, 
project editor.-- 2nd ed. 
p. ; cm. 

Includes bibliographical references and index. 

ISBN 0-7876-7424-9 (set hardcover : alk. paper) - ISBN 0-7876-7425-7 (v. 1 : alk. 
paper) ~ ISBN 0-7876-7426-5 (v. 2 : alk. paper) - ISBN 0-7876-7427-3 (v. 3 : alk. 
paper) -- ISBN 0-7876-7428-1 (v. 4 : alk. paper) 

1. Alternative medicine— Encyclopedias. 

[DNLM: 1. Complementary Therapies— Encyclopedias-English. 2. Internal 

Encyclopedias-English. WB 13 G1507 2005] I. Title: Encyclopedia of 
alternative medicine. II. Longe, Jacqueline L. 

R733.G34 2005 
61 5.5'03— dc22 


This title is also available as an e-book 
ISBN 7876-9396-0 (set) 

Contact your Gale sales representative for ordering information 

ISBN 0-7876-7424-9(set) 

0-7876-7425-7 (Vol. 1) 

0-7876-7426-5 (Vol. 2) 

0-7876-7427-3 (Vol. 3) 

0-7876-7428-1 (Vol. 4) 

Printed in the United States of America 
1098765432 1 


List of Entries vii 

About the Encyclopedia xvii 

Advisory Board xix 

Contributors xxi 


Volume 1: A-C 1 

Volume 2: D-K 523 

Volume 3: L-R 1029 

Volume 4: S-Z 1523 

Organizations 2199 

Glossary 2225 

General Index 2293 





Bates method 

1 A 







Applied kinesiology 



Apricot seed 

Bee pollen 



Behavioral optometry 



Behavioral therapy 







Adie’s pupil 

Arsenicum album 

Beta-methylbutyric acid 

African pygeum 

Art therapy 

Beta carotene 



Betaine hydrochloride 



Bhakti yoga 






Binge eating disorder 

Alexander technique 







Athlete’s foot 



Atkins diet 


Allium cepa 

Atractylodes (white) 

Bipolar disorder 


Attention-deficit hyperactivity dis- 

Bird flu 



Bites and stings 

Alzheimer’s disease 


Bitter melon 

Amino acids 

Auditory integration training 



Aura therapy 

Black cohosh 



Black currant seed oil 



Black haw 


Ayurvedic medicine 

Black walnut 

Angelica root 

Black cumin seed extract 


Bladder cancer 


1 B 

Bladder infection 

Ankylosing spondylitis 

Blessed thistle 

Anorexia nervosa 

Bad breath 


Anthroposophical medicine 

Balm of Gilead 

Blood poisoning 



Blood clots 


Barley grass 




List of Entries 

Blue cohosh 
Body odor 

Bone spurs 



Borage oil 



Botanical medicine 

Breast cancer 

Breastfeeding problems 

Breath therapy 


Brewer’s yeast 









Bulimia nervosa 


Burdock root 



Butcher’s broom 


Cadmium poisoning 

Calcarea carbonica 

Cancer treatments, biological 


Canker sores 




Carpal tunnel syndrome 

Cartilage supplements 

Castor oil 

Cat’s claw 



Cayce systems 
Celiac disease 
Cell therapy 
Cell salt therapy 

Cerebral vascular insufficiency 

Cerebral palsy 

Cervical dysplasia 

Chakra balancing 


Charcoal, activated 

Chasteberry tree 

Chelated minerals 

Chelation therapy 

Chemical poisoning 

Cherry bark 





Childhood nutrition 


Chinese massage 

Chinese system of food cures 

Chinese thoroughwax 

Chinese yam 

Chinese foxglove root 






Christian Science healing 

Chronic fatigue syndrome 
Chrysanthemum flower 

Cinnamon bark 
Cnidium seeds 
Codonopsis root 

Coenzyme Q 1() 


Cold sores 



Colloidal silver 

Colonic irrigation 

Color therapy 

Colorectal cancer 




Common cold 



Contact dermatitis 




Corns and calluses 




Cotton root bark 


Cradle cap 

Cramp bark 


Craniosacral therapy 
Crohn’s disease 

Crystal healing 

Cuts and scratches 
Cymatic therapy 


Dance therapy 



Deglycyrrhizanated licorice 

Evening primrose oil 



Evodia fruit 

Genital herpes 



Genital warts 





Geriatric massage 

Devil’s claw 

Gerson therapy 



Diabetes mellitus 


Ginkgo biloba 

Diamond diet 

Facial massage 

Ginseng, American 

Diaper rash 


Ginseng, Korean 



Ginseng, Siberian 





Feng shui 


Digestive enzymes 







Ferrum phosphoricum 





Dong quai 



Dry mouth 

Fibrocystic breast disease 

Gotu kola 





Fish oil 

Grains-of-paradise fruit 


Grape skin 


Grape seed extract 

Flower remedies 

Grapefruit seed extract 


Fo ti 

Green tea 

Ear infection 

Folic acid 



Food poisoning 

Guided imagery 



Gulf War syndrome 



Gum disease 


French green clay 





Frostbite and frostnip 

Elimination diet 

Fungal infections 




Flair loss 

Energy medicine 


Environmental therapy 


Flatha yoga 

Enzyme therapy 




Gamma-linoleic acid 

Hay fever 






Hearing loss 



Heart disease 

Essential fatty acids 


Heart attack 

Essential oils 



Essiac tea 


Heavy metal poisoning 



Heel spurs 

Eucommia bark 





List of Entries 

List of Entries 

Hepar sulphuris 

Herbalism, Western 

Herbalism, traditional Chinese 

Herniated disk 

Hiatal hernia 



High sensitivity C reactive protein 

High-fiber diet 

Hodgkin’s disease 
Holistic dentistry 
Holistic medicine 

Homeopathy, acute prescribing 
Homeopathy, constitutional pre- 

Horse chestnut 
Hot flashes 
Humor therapy 












I I 

Iceland moss 

Immuno-augmentation therapy 




Infant massage 



Inflammatory bowel disease 


Ingrown nail 


Insulin resistance 






Irritable bowel syndrome 




Jet lag 
Jock itch 
Jojoba oil 
Journal therapy 
Juice therapies 

Juvenile rheumatoid arthritis 


Kali bichromicum 
Kampo medicine 
Kaposi’s sarcoma 
Kava kava 
Kegel exercises 
Kelley-Gonzalez diet 

Kidney stones 
Kidney infections 
Kirlian photography 
Knee pain 
Kneipp wellness 
Kola nut 

I L 

Labyrinth walking 

Lacto-ovo vegetarianism 



Lazy eye 

Lead poisoning 

Learning disorders 



Lemon balm 



Lice infestation 


Light therapy 

Linoleic acid 

Livingston- Wheeler therapy 




Lou Gehrig’s disease 

Low back pain 

Lung cancer 


Lycium fruit 



Lyme disease 

Lymphatic drainage 




Macrobiotic diet 

Macular degeneration 


Magnetic therapy 




Malignant lymphoma 




Marsh mallow 

Martial arts 

Massage therapy 

McDougall diet 



Mediterranean diet 

Medium-chain triglycerides 


Memory loss 

Meniere’s disease 




Mercurius vivus 


Metabolic therapies 


Mexican yam 

Migraine headache 

Milk thistle 

Mind/Body medicine 



Morning sickness 


Motion sickness 

Movement therapy 



Mugwort leaf 

Multiple chemical sensitivity 
Multiple sclerosis 

Muscle spasms and cramps 

Music therapy 






Native American medicine 

Natrum muriaticum 
Natural hygiene diet 
Natural hormone replacement ther- 

Naturopathic medicine 


Neck pain 



Neural therapy 

Neurolinguistic programming 

Night blindness 

Notoginseng root 
Nux vomica 




Obsessive-compulsive disorder 
Omega-3 fatty acids 
Omega-6 fatty acids 
Oregano essential oil 
Ornish diet 
Orthomolecular medicine 

Ovarian cancer 
Ovarian cysts 
Oxygen/Ozone therapy 



Paleolithic diet 

Panic disorder 
Pantothenic acid 
Parasitic infections 
Parkinson’s disease 
Past-life therapy 
Pau d'arco 

Pelvic inflammatory disease 



Peripheral neuropathy 


Pet therapy 





Pinched nerve 

Pine bark extract 


Pityriasis rosea 

Placebo effect 




Polarity therapy 

Postpartum depression 

Post-traumatic stress disorder 


Pranic healing 

Prayer and spirituality 


Pregnancy massage 

Premenstrual syndrome 

Prickly heat 

Prickly pear cactus 

Pritikin diet 



Prostate enlargement 

Prostate cancer 


Psychosomatic medicine 



List of Entries 

List of Entries 

Pulse diagnosis 


Quan yin 



Radiation injuries 





Raynaud’s syndrome 

Red cedar 

Red clover 

Red yeast rice extract 



Reishi mushroom 


Rescue Remedy 

Restless leg syndrome 

Retinal detachment 


Rheumatic fever 

Rheumatoid arthritis 


Rhubarb root 

Rhus toxicodendron 




Rose hip 


Rosen method 

Royal jelly 


Rubenfeld synergy 

Russian massage 

I s 

Safflower flower 



Saliva sample testing 

Sargassum seaweed 


Saw palmetto 



Scarlet fever 





Seasonal affective disorder 


Senior nutrition 


Sensory deprivation 

Sensory integration disorder 


Sesame oil 

Sexual dysfunction 


Sheep sorrel 


Shiitake mushroom 
Shin splints 

Sick building syndrome 
Sickle cell anemia 

Sinus infection 
Sjogren’s syndrome 
Skin cancer 
Sleep apnea 
Sleep disorders 
Slippery elm 

Sore throat 
Sound therapy 
South Beach diet 
Soy protein 

Spinal manipulative therapy 


Sports massage 

Sprains and strains 


St. John’s wort 

Staphylococcal infections 


Stone massage 
Strep throat 

Substance abuse and dependence 



Sun’s soup 


Swedish massage 
Sweet clover 
Swimmer’s ear 
Syntonic optometry 

Systemic lupus erythematoses 


T’ai chi 
Tangerine peel 
Tea tree oil 
Teenage nutrition 
Teething problems 
Temporomandibular joint syn- 
Tennis elbow 
Thai massage 



Therapeutic touch 

Uterine cancer 



Uterine fibroids 

White peony root 


Uva ursi 

White willow 

Thunder God vine 

Whooping cough 


Wigmore diet 

Tibetan medicine 

Wild cherry 



Wild oat 



Wild yam 




Tourette syndrome 


Witch hazel 

Toxic shock syndrome 

Varicose veins 


Traditional African medicine 



Traditional Chinese medicine 



Trager psychophysical integration 

Venom immunotherapy 


Vitamin A 


Vitamin B complex 


Vitamin B ] , 

■ Y 

Trigger point therapy 

Vitamin C 



Vitamin D 

Yeast infection 


Vitamin E 

Yellow dock 


Vitamin K 

Yerba santa 







Ulcers, digestive 





Urinary incontinence 



Urine therapy 

Wheat grass therapy 



Wheat germ 

Zone diet 



List of Entries 


The Gale Encyclopedia of Alternative Medicine is a 
medical reference product designed to inform and edu- 
cate readers about a wide variety of complementary ther- 
apies and herbal remedies and treatments for prevalent 
conditions and diseases. Thomson Gale believes the 
product to be comprehensive, but not necessarily defini- 
tive. It is intended to supplement, not replace, consulta- 
tion with a physician or other healthcare practitioner. 
While Thomson Gale has made substantial efforts to pro- 
vide information that is accurate, comprehensive, and 
up-to-date, Thomson Gale makes no representations or 

warranties of any kind, including without limitation, 
warranties of merchantability or fitness for a particular 
purpose, nor does it guarantee the accuracy, comprehen- 
siveness, or timeliness of the information contained in 
this product. Readers should be aware that the universe 
of complementary medical knowledge is constantly 
growing and changing, and that differences of medical 
opinion exist among authorities. They are also advised to 
seek professional diagnosis and treatment for any med- 
ical condition, and to discuss information obtained from 
this book with their healthcare provider. 




The Gale Encyclopedia of Alternative Medicine 
(GEAM) is a one-stop source for alternative medical in- 
formation that covers complementary therapies, herbs 
and remedies, and common medical diseases and condi- 
tions. It avoids medical jargon, making it easier for the 
layperson to use. The Gale Encyclopedia of Alternative 
Medicine presents authoritative, balanced information 
and is more comprehensive than single-volume family 
medical guides. 


Over 800 full-length articles are included in The 
Gale Encyclopedia of Alternative Medicine. Many 
prominent figures are highlighted as sidebar biographies 
that accompany the therapy entries. Articles follow a 
standardized format that provides information at a 
glance. Rubrics include: 


• Origins 

• Benefits 

• Description 

• Preparations 

• Precautions 

• Side effects 

• Research & general acceptance 

• Resources 

• Key terms 


• General use 

• Preparations 

• Precautions 

• Side effects 

• Interactions 

• Resources 

• Key terms 



• Definition 

• Description 

• Causes & symptoms 

• Diagnosis 

• Treatment 

• Allopathic treatment 

• Expected results 

• Prevention 

• Resources 

• Key terms 

Inclusion criteria 

A preliminary list of therapies, herbs, remedies, dis- 
eases, and conditions was compiled from a wide variety 
of sources, including professional medical guides and 
textbooks, as well as consumer guides and encyclope- 
dias. The advisory board, made up of three medical and 
alternative healthcare experts, evaluated the topics and 
made suggestions for inclusion. Final selection of topics 
to include was made by the medical advisors in conjunc- 
tion with Thomson Gale editors. 

About the Contributors 

The essays were compiled by experienced medical 
writers, including alternative healthcare practitioners and 
educators, pharmacists, nurses, and other complementary 
healthcare professionals. GEAM medical advisors re- 
viewed over 95% of the completed essays to insure that 
they are appropriate, up-to-date, and medically accurate. 

How to Use this Book 

The Gale Encyclopedia of Alternative Medicine has 
been designed with ready reference in mind: 

• Straight alphabetical arrangement allows users 
to locate information quickly. 


About the Encyclopedia 

• Bold faced terms function as print hyperlinks that 
point the reader to related entries in the encyclo- 

• A list of key terms is provided where appropriate 
to define unfamiliar words or concepts used with- 
in the context of the essay. Additional terms may 
be found in the glossary. 

• Cross-references placed throughout the encyclo- 
pedia direct readers to where information on sub- 
jects without their own entries can be found. Syn- 
onyms are also cross-referenced. 

• A Resources section directs users to sources of 
further complementary medical information. 

• An appendix of alternative medical organizations 
is arranged by type of therapy and includes valu- 
able contact information. 

• A comprehensive general index allows users to 
easily target detailed aspects of any topic, includ- 
ing Latin names. 


The Gale Encyclopedia of Alternative Medicine is 
enhanced with over 450 images, including photos, ta- 
bles, and customized line drawings. Each volume con- 
tains a color insert of 64 important herbs, remedies, and 




An advisory board made up of prominent individuals from complementary medical 
communities provided invaluable assistance in the formulation of this encyclopedia. 
They defined the scope of coverage and reviewed individual entries for accuracy and 
accessibility. We would therefore like to express our appreciation to them: 

Mirka Knaster, PhD 

author, editor, consultant in Eastern and Western body-mind disciplines and spiritual traditions 
Oakland, CA 

Lisa Meserole, MS, ND 
President, Botanical Medicine Academy 
One Sky Medicine Clinic 
Seattle, WA 

Katherine E. Nelson, ND 

Naturopathic Physician 
Naples, FL 

Jamison Starbuck, JD, ND 

Naturopathic Family Physician 

Former president, American Association of Naturopathic Physicians 
Member, Homeopathic Academy of Naturopathic Physicians 
Missoula, MT 




Margaret Alic, PhD 

Medical Writer 
Eastsound, WA 

Greg Annussek 
Medical Writer 

American Society of Journalists and Authors 
New York, NY 

Barbara Boughton 

Health and Medical Writer 
El Cerrito, CA 

Ruth Ann Prag Carter 

Freelance Writer 
Farmington Hills, MI 

Linda Chrisman 

Massage Therapist and Educator 
Medical Writer 
Oakland, CA 

Gloria Cooksey, CNE 
Medical Writer 
Sacramento, CA 

Amy Cooper, MA, MSI 
Medical Writer 
Vermillion, SD 

Sharon Crawford 

Writer, Editor, Researcher 
American Medical Writers Association 
Periodical Writers Association of Canada and the Editors’ 
Association of Canada 
Toronto, ONT Canada 

Sandra Bain Cushman 

Massage Therapist 

Alexander Technique Practitioner and Educator 
Charlottesville, VA 

Tish Davidson, MA 

Medical Writer 
Fremont, CA 

Lori DeMilto, MJ 

Medical Writer 
Sicklerville, NJ 

Doug Dupler, MA 

Medical Writer 
Boulder, CO 

Paula Ford-Martin, PhD 

Medical Writer 
Warwick, RI 

Rebecca J. Frey, PhD 

Medical Writer 
New Haven, CT 

Lisa Frick 

Medical Writer 
Columbia, MO 

Kathleen Goss 
Medical Writer 
Darwin, CA 

Elliot Greene, MA 

former president, American Massage Therapy Association 
Massage Therapist 
Silver Spring, MD 

Peter Gregutt 

Medical Writer 
Asheville, NC 

Clare Hanrahan 

Medical Writer 
Asheville, NC 

David Helwig 

Medical Writer 
London, ONT Canada 

Beth A. Kapes 

Medical Writer, Editor 
Bay Village, OH 

Katherine Kim 

Medical Writer 
Oakland, CA 

Erika Lenz 

Medical Writer 
Lafayette, CO 

Lorraine Lica, PhD 

Medical Writer 
San Diego, CA 




Whitney Lowe, LMT 

Orthopedic Massage Education & Research Institute 
Massage Therapy Educator 
Bend, OR 

Mary McNulty 

Freelance Writer 
St.Charles, IL 

Kathy Shepard Stolley, PhD 

Medical Writer 
Virginia Beach, VA 

Judith Sims, MS 

Science Writer 
Logan, UT 

Katherine E. Nelson, ND 

Naturopathic physician 
Naples, FL 

Patricia Skinner 

Medical Writer 
Amman, Jordan 

Teresa Odle 

Medical Writer 
Ute Park, NM 

Genevieve Slomski, PhD 

Medical Writer 
New Britain, CT 

Jodi Ohlsen Read 

Medical Writer 
Carver, MN 

Jane E. Spear 

Medical Writer 
Canton, OH 

Carole Osborne-Sheets 

Massage Therapist and Educator 
Medical Writer 
Poway, CA 

Lee Ann Paradise 

Freelance Writer 
Lubbock, TX 

Liz Swain 

Medical Writer 
San Diego, CA 

Judith Turner, DVM 

Medical Writer 
Sandy, UT 

Patience Paradox 

Medical Writer 
Bainbridge Island, WA 

Samuel Uretsky, PharmD 

Medical Writer 
Wantagh, NY 

Belinda Rowland, PhD 

Medical Writer 
Voorheesville, NY 

Ken R. Wells 

Science Writer 
Laguna Hills, CA 

Joan M. Schonbeck, RN 

Medical Writer 
Marlborough, MA 

Angela Woodward 

Science Writer 
Madison, WI 

Gabriele Schubert, MS 

Medical Writer 
San Diego, CA 

Kathleen Wright, RN 

Medical Writer 
Delrnar, DE 

Kim Sharp, M Ln 

Medical Writer 
Houston, TX 

Jennifer L. Wurges 

Medical Writer 
Rochester Hills, MI 




Abdominal pain see Stomachaches 



An abscess is a place of accumulation of the creamy 
white, yellow, or greenish fluid, known as pus, surround- 
ed by reddened tissue. It is the result of the body’s in- 
flammatory response to a foreign body or a bacterial, 
viral, parasitic, or fungal infection. An abscess usually 
dries out and resolves when it is drained of pus. The 
most common parts of the body affected by abscesses 
are the face, armpits, arms and legs, rectum, sebaceous 
glands (oil glands), and the breast during lactation. 


Most abscesses are septic, which means they are the 
result of an infection. Abscesses occur when white blood 
cells ( WBCs) gather in response to an infection. They pro- 
duce oxidants (for example, superoxide radical) and en- 
zymes to digest the invading bacteria, viruses, parasites, or 
fungi. The infective agents are then broken down by the 
WBCs into small pieces that can be transported through 
the bloodstream and eliminated from the body. Unfortu- 
nately, the enzymes may also digest part of the body’s tis- 
sues along with the infective agents. The resulting liquid 
of this digestion is pus, which contains the remains of the 
infective agents, tissue, white blood cells, and enzymes. 

A sterile abscess is one that is not produced by an 
infection. It is caused by irritants, such as foreign bodies 
or injected drugs, and medications that have not been to- 
tally absorbed. Sterile abscesses quite often heal into 
hardened scar tissue. 

Common types of abscesses: 

• Boils and carbuncles. Sebaceous glands and superficial 
skin are the places usually infected. 


• Dental abscess. An abscess that develops along the root 
of a tooth. 

• Pilonidal abscess. People who have a birth defect in- 
volving a tiny opening in the skin just above the anus 
may have fecal bacteria enter this opening, causing an 
infection and a subsequent abscess. 

• Retropharyngeal, parapharyngeal, peritonsillar abscess. 
As a result of throat infections like strep throat and 
tonsillitis, bacteria invade the deeper tissues of the 
throat and cause a parapharyngeal or peritonsillar ab- 
scess. A retropharyngeal abscess is a result of some- 
thing usually blood-borne, and not from a direct spread 
of tonsillitis. These abscesses can compromise swal- 
lowing and even breathing. 

• Lung abscess. During or after pneumonia, an abscess 
can develop as a complication. 

• Liver abscess. Bacteria, parasites, or amoeba from the 
intestines can spread through the blood to the liver and 
cause abscesses. 

• Psoas abscess. An abscess can develop in the psoas 
muscles, when an infection spreads from the appendix, 
the large intestine, or the fallopian tubes. 

• Butin abscess. Any blood-borne feeding off bacteria 
that stimulate pus production (pyogenic organisms). 
Can cause abscesses in possibly many sites. 

Causes & symptoms 

Many different agents cause abscesses. The most 
common are the pyogenic, or pus-forming bacteria, such 
as Staphylococcus aureus, which is nearly always the 
cause of abscesses directly under the skin. Abscesses are 
usually caused by organisms that normally inhabit near- 
by structures or that infect them. For example, abscesses 
around the anus may be caused by any of the numerous 
bacteria found within the large intestine. Brain abscesses 
and liver abscesses are caused by the bacteria, amoeba, 
and fungi that are able to travel there through circulation. 



An amoebic abscess caused by Entameoba histolytica. 

(Phototake NYC. Reproduced by permission.) 

Symptoms of an abscess are the general signs of in- 
flammation. Symptoms that identify superficial abscess- 
es include heat, redness, swelling, and pain over the af- 
fected area. Abscesses in other places may produce only 
generalized symptoms, such as fever and discomfort. A 
sterile abscess may present as painful lump deep under 
the site of an injection. A severe infection may bring on 
fever, fatigue, weight loss, and chills. Recurrent abscess- 
es may indicate undiscovered allergies or decreased im- 
mune functioning. 


A general physical examination and a detailed pa- 
tient history are used to diagnose an abscess. Recent or 
chronic disease or dysfunction in an organ suggests it 
may be the site of an abscess. Pain and tenderness on 
physical examination are common findings. There may 
also be a leakage of pus from a sinus tract connected to 
an abscess deep in the body tissue. 


Bentonite clay packs with a small amount of gold- 
enseal powder (Hydrastis canandensis ) can be placed on 
the site of a superficial abscess and used to draw out the 
infection. Tea tree oil ( Melaleuca spp.) and garlic (Alli- 
um sativa) directly applied to abscesses may also help to 
clear them. 

Applications of a hot compress to the skin over the 
abscess will hasten the draining or the reabsorption of 
the abscess. Contrast hydrotherapy, using alternating 
hot and cold compresses, can also be used. Additionally, 
localized warm/hot soaks three to five times daily fre- 
quently brings an abscess to heal. 

Homeopathic remedies that can be taken to help di- 
minish abscess formation include belladonna, silica, 


Hepar sulphuris, and calendula. Also, acupuncture 
may be recommended to help treat pain caused by an ab- 
scess. In addition, vitamins A and C, beta-carotene, zinc, 
liquid chlorophyll, and garlic are useful as supportive 
daily nutrients to help clear up abscesses. 

Allopathic treatment 

Often, the pus of an abscess must be drained by a 
physician. Ordinarily, the body will handle the remain- 
ing infection. Sometimes antibiotics are prescribed. The 
doctor may often put a piece of cloth or rubber, called a 
drain, in the cavity of the abscess to prevent it from clos- 
ing until all the pus has drained. 

Expected results 

Once the abscess is properly drained, it should clear 
up in a few days. Any underlying diseases will determine 
the overall outcome of the condition. Recurrent abscesses, 
especially those on the skin, return due to either defec- 
tive/altered immunity, or staph overgrowth, where there is 
high bacterial colonization on the skin. The patient should 
consult a physician for treatment with which to wash the 
skin areas, and treatment to eradicate colonization. 

If the abscess ruptures into neighboring areas or if 
the infectious agent spills into the bloodstream, serious 
consequences are likely. Abscesses in and around the 
nasal sinuses, face, ears, and scalp may spread the infec- 
tion into the brain. Abscesses in the abdominal cavity, 
such as in the liver, may rupture into that cavity. Blood 
poisoning, or septicemia, is an infection that has spilled 
into the bloodstream and then spreads throughout the 
body. These are emergency situations where the patient 
needs to be seen by a physician as soon as possible. 

It is important to take note that abscesses in the 
hand may be more serious than they might appear. Due 
to the intricate structure and the overriding importance 
of the hand, any hand infection must be treated prompt- 
ly and competently. 


Infections that are treated early with heat, if superfi- 
cial, or antibiotics, if deeper, will often resolve without 
the formation of an abscess. It is even better to avoid in- 
fections altogether by promptly cleaning and irrigating 
open injuries, particularly bites and puncture wounds. 



Bennett, J. Claude and Fred Plum, ed. Cecil Textbook of Medi- 
cine. Philadelphia: W. B. Saunders Co., 1996. 



Bentonite clay — A green clay of aluminum silicate 
containing magnesium and trace minerals. The 
clay has the ability to attract and hold to its sur- 
face agents of infection from a wound. 

Enzyme — A protein that can increase the rate of 
chemical reactions. 

Sinus tract — A channel connecting a body part 
with the skin outside. 

Duke, James A., et at. The Green Pharmacy. Pennsylvania: Ro- 
dale, 1997. 

Isselbacher, Kurt, et at, ed. Harrison’s Principles of Internal 
Medicine. New York: McGraw-Hill, 1997. 

Tierney, Jr., Lawrence M., et al, ed. Current Medical Diagnosis 
and Treatment. Connecticut: Appleton & Lange, 1996. 

OTHER <http://www.alternativemedicine. 
com/> (December 28, 2000). 

Patience Paradox 

Absinthe see Wormwood 

Aches and pains see Pain 



Lactobacillus acidophilus , commonly referred to 
simply as acidophilus, is a friendly inhabitant of the gas- 
trointestinal (GI) tract. It, as well as some related strains 
of bacteria, is known as a probiotic. Probiotic organisms 
secrete enzymes that support healthy digestion. They 
keep the flora of the intestines and vagina balanced, and 
compete with some pathogenic organisms. When the pro- 
biotic population of the body is severely decreased, as 
can occur with treatment by many antibiotics, yeasts and 
harmful bacteria may take over and cause illness. Normal 
and healthy amounts of acidophilus can also be decreased 
by chronic diarrhea, stress, infections, and poor diet. 

The species of Lactobacilli that inhabit the GI tract 
cause an increase of acidity. The bacteria do this by pro- 
ducing lactic acid from milk sugar (lactose). The in- 
creased acidity may promote the absorption of calcium, 
as well as of some other minerals. Lowered pH also dis- 


courages the growth of many pathogenic species of bac- 
teria and yeasts. The hydrogen peroxide produced by the 
acidophilus also helps to suppress pathogens. 

Acidophilus may function in the production of some 
of the B vitamins, such as niacin, pyridoxine, biotin, 
and folic acid. 

General use 

Yeast infections 

Acidophilus may be used to reduce susceptibility to 
vaginal yeast infections, which are quite common. 
Symptoms including itching, burning, inflammation, 
and discharge occur due to an overgrowth of the yeast 
Candida albicans , which is part of the normal vaginal 
flora. Some women are more prone to yeast infections 
than others. Antibiotics destroy the normal probiotic 
flora, and may lead to yeast infections. High sugar levels 
are another predisposing factor. Diabetics, who tend to 
have high blood sugar, and persons who consume a 
processed diet that is high in sugar have more frequent 
problems with yeast as well. The hormonal states created 
by pregnancy or the use of oral contraceptives also con- 
tribute to yeast infections. IUD users can also have an in- 
creased rate of infection. In rare cases, Candida is sexu- 
ally transmitted, and both partners may require treatment 
in order to control repeated overgrowth. Anyone who has 
AIDS or any other condition causing immunosuppres- 
sion has increased susceptibility to Candida and other 
types of infections too. Acidophilus is one of the organ- 
isms that competes with Candida and decreases its popu- 
lation. Many studies have shown that oral and topical use 
(by douching) of acidophilus are effective to prevent and 
treat this condition. 

Systemic candidiasis, or yeast hypersensitivity syn- 
drome, is a condition that is not recognized by many al- 
lopaths. It is acknowledged by some practitioners of al- 
ternative and complementary medicine as a problem 
with broad-ranging consequences. This theory holds that 
some people have an allergic reaction to the yeast and/or 
its toxins, and that they can experience serious symp- 
toms when the organism multiplies in the body to an ab- 
normal degree. Fatigue, diarrhea, constipation, muscle 
pain, thrush, itching, mood changes, endocrine dysfunc- 
tion, headaches, and tingling or numbness of the extrem- 
ities are some of the symptoms that are reportedly asso- 
ciated with systemic candidiasis. A weak immune sys- 
tem may be more prone to allowing yeast to multiply, 
and large numbers of yeast can act to further suppress 
the immune function. Acidophilus, in combination with 
such nutritional supplements as essential fatty acids, is 
often recommended for the prevention and treatment of 
this syndrome. 




Gastrointestinal disorders 

Irritable bowel syndrome (IBS) is a functional dis- 
turbance of the lower intestine that can cause bloating, 
cramping, abdominal pain, diarrhea, constipation, and 
painful bowel movements. This condition is also known 
as spastic colon. One small study of the use of aci- 
dophilus to treat IBS showed more improvement in the 
treated group than in those who took a placebo. This is 
not conclusive evidence, but in view of the safety of the 
treatment and the scarcity of effective alternatives, aci- 
dophilus may be worth trying. 

Traveler’s diarrhea is sometimes suffered by peo- 
ple who consume contaminated food or water in other 
countries. Some evidence shows that regular use of 
acidophilus and other probiotics may prevent this con- 

High cholesterol levels 

Recent evidence suggests that consuming Lacto- 
bacillus acidophilus LI can be effective in lowering 
blood cholesterol. The February 1999 issue of the 
Journal of the American College of Nutrition reports on 
two studies done at the University of Kentucky. Sub- 
jects who consumed the yogurt containing L. aci- 
dophilus LI had cholesterol levels drop by 2.4% in one 
study and 3.2% in the other. Although the percentages 
are small, the effect on the risk of heart disease could 
be significant. 

Immune response 

A study published in the December 1998 issue of 
the Brazilian Journal of Medical and Biological Re- 
search found that acidophilus induced a nonspecific 
immune response in experimental mice. Acidophilus is 
sometimes recommended as an immune booster for 
people, although the effect has not yet been document- 
ed in humans. 

Other uses 

Acidophilus may possibly be helpful in the treat- 
ment of canker sores, fever blisters, hives, and adoles- 
cent acne. Its use has also been suggested as a preventa- 
tive for colon cancer. 


Acidophilus is taken by mouth. It is available as 
powder, liquid, tablets, or capsules, and is also present 
in some types of milk, kefir, yogurt, and some cheeses. 
Frozen yogurt does not contain live probiotics. Check 
product labels to see whether live organisms are present. 
The bacteria are killed by pasteurization. Probiotic 



Candidiasis — Any of a variety of infections caused 
by fungi of the genus Candida. 

Probiotic — Any strain of bacteria that lives in the 
human gut and is considered a "friendly" bacteri- 
um. Probiotics secrete enzymes that help to keep 
the digestive system balanced, and compete with 
some pathogenic organisms. Acidophilus is one of 
the best-known probiotics. 

Traveler's diarrhea — Diarrhea caused by ingesting 
local bacteria to which one's digestive system has 
not yet adapted. 

products are most potent when kept refrigerated. The 
potency of a given preparation is usually expressed as 
the number of organisms per capsule. A usual dose of 
acidophilus is 1-10 billion organisms, divided into three 
doses per day. 


People who are lactose-intolerant may also not tol- 
erate acidophilus. 

Side effects 

The initial use of acidophilus may cause an increase 
in intestinal gas, which decreases with continued use of 
the product. 


Taking acidophilus in conjunction with some antibi- 
otics, including ampicillin (Amcill, Ampicin) and amox- 
icillin (Amoxil, Novamoxin), can prevent the diarrhea 
that is sometimes caused by their use. 



Bratman, Steven, and David Kroll. Natural Health Bible. 

Rocklin, CA: Prima Publishing, 1999. 

Jellin, Jeff, Forrest Batz, and Kathy Hitchens. Pharmacist’ s let- 
ter/Prescriber’s Letter Natural Medicines Comprehensive 
Database. California: Therapeutic Research Faculty, 

Lininger, Skye. The Natural Pharmacy. Rocklin, CA: Prima 
Health, 1998. 

Judith Turner 




Acne is a common inflammatory skin disease char- 
acterized by pimples on the face, chest, and back. It oc- 
curs when the pores of the skin become clogged with oil, 
dead skin cells, and/or bacteria. 


Acne vulgaris, the medical term for common acne, 
is the most common skin disease. It affects nearly 17 
million people in the United States. While acne can arise 
at any age, it usually begins at puberty and worsens dur- 
ing adolescence. Nearly 85% of people develop acne 
some time between the ages of 12 and 25 years old. Up 
to 20% of women develop mild acne. It is also found in 
some newborns. 

The sebaceous glands lie just beneath the skin’s 
surface. They produce sebum, an oily secretion that 
helps to preserve the flexibility of the hair and moistur- 
izes the skin. These glands and the hair follicles within 
which they are found are called sebaceous follicles. 
These follicles open onto the skin through pores that 
allow the sebum to reach the hair shaft and the skin. In 
certain situations, the glands excrete excess sebum and 
it cannot be cleared from the pores efficiently. This 
happens, for instance, at puberty when increased levels 
of the androgen hormones cause overproduction of 
sebum. In addition, cells lining the follicle are shed too 
quickly and begin to clump together. The excess sebum 
combines with the dead cells and forms a plug, or 
comedo (also called comedones), that blocks the pore, 
which is not usually seen. When the follicle begins to 
bulge and show up as a small whitish bump mostly 
under the skin, it is called a whitehead. If the comedo 
opens up, the top surface of the plug darkens, and it is 
referred to as a blackhead. 

Infection results when a plugged follicle is invaded 
by Propionibacterium acnes, a bacteria that normally 
lives on the skin, and possibly other microorganisms. 
The bacteria produce chemicals and enzymes that bring 
on inflammation. Pimples are the result of infected 
blackheads or whiteheads that rupture, releasing sebum, 
bacteria, dead skin, and white blood cells onto the sur- 
rounding tissues. Inflamed pimples near the skin’s sur- 
face are called papules; they are red and raised, and may 
be quite tender to the touch. The papules may become 
filled with pus, and are then called pustules. If the folli- 
cle continues to enlarge rather than rupture, it forms a 
closed sac, called a cyst, which can be felt as a lump 
under the skin. Large hard swellings deep within the skin 


Acne vulgaris affecting a woman’s face. Acne is the general 
name given to a skin disorder in which the sebaceous 
glands become inflamed. (Photograph by Biophoto Associ- 
ates, Photo Researchers, Inc. Reproduced by permission.) 

are called nodules. Both nodules and cysts may cause 
pain and scarring. 

Causes & symptoms 

The exact cause of acne is mostly unknown. Some- 
times when acne in women is due to excess male hor- 
mone production, it is diagnosed by an onset of the con- 
dition in adulthood; excessive growth of hair, especially 
in places not usual on a female, called hirsuitism; irregu- 
lar menstrual cycles; and premenstrual flare-ups of acne. 
A 2001 study demonstrated that menstrual cycle does af- 
fect acne. Surprisingly, the study revealed that 53% of 
women over age 33 experienced a higher premenstrual 
acne rate than women under age 20. 

Many alternative practitioners assert that acne is 
often related to a condition of toxicity in the intestines or 
liver. This may be due to the presence of bacteria such as 
Clostridia spp. and Yersinia enterocolitica, a low-fiber 



diet; a lack of friendly gut flora such as Lactobacillus 
spp.; an intestinal overgrowth of Candida albicans; and 
food allergies. 

The interaction between the body’s hormones, skin 
protein, skin secretions, and bacteria determines the 
course of acne. Several other factors have also been 
shown to affect the condition: 

• Age. Teenagers are more likely than anyone to develop 

• Gender. Boys have more severe acne and develop it 
more often than girls. 

• Disease. Hormonal disorders can complicate acne in 

• Heredity. Individuals with a family history of acne have 
greater susceptibility to the condition. 

• Hormonal changes. Acne can flare up before menstru- 
ation, during pregnancy, and menopause. 

• Diet. Although they are not the primary cause of acne, 
certain foods may bring on flare-ups or make the con- 
dition worse. 

• Drugs. Acne can be a side effect of antibiotics, oral 
contraceptives, and anabolic steroids. 

• Personal hygiene. Use of abrasive soaps, hard scrub- 
bing of the face, or handling pimples will often make 
them worse. 

• Cosmetics. Oil-based makeup and hair sprays worsen 

• Environment. Exposure to oils and greases, polluted 
air, and sweating in hot weather can all aggravate acne. 

• Stress. Emotional stress may contribute to acne. 

• Friction. Continual pressure or rubbing on the skin by 
such things as bicycle helmets, backpacks, or tight 
clothing, as well as hard scrubbing of the skin, can 
worsen acne. 

The most common sites of acne are the face, chest, 
shoulders, and back, since these are the parts of the body 
where the most sebaceous follicles are found. In 
teenagers, acne is often found on the forehead, nose, and 
chin. As people get older, it tends to appear towards the 
outer part of the face. Adult women may have acne on 
their chins and around their mouths. The elderly often de- 
velop whiteheads and blackheads on the upper cheeks and 
skin around the eyes. Inflamed lesions may cause redness, 
pain, tenderness, itching, or swelling in affected areas. 


Acne has a characteristic appearance and is, there- 
fore, not difficult to diagnose. A complete medical histo- 


ry should be taken, including questions about skin care, 
diet, factors that improve or worsen the condition, med- 
ication use, and prior treatment. Physical examination 
includes the face, upper neck, chest, shoulders, back, and 
other affected areas. Under good lighting, the doctor can 
determine what types and how many blemishes are pre- 
sent, whether they are inflamed, whether they are deep 
or superficial, and whether there is scarring or skin dis- 
coloration. Blood tests are done when the patient appears 
to have hormonal or other medical problems. Stool tests 
can be helpful in determining whether there is a bacterial 
or yeast overgrowth contributing to the condition. Food 
allergy testing should also be considered. 


Alternative treatments for acne focus on proper 
cleansing to keep the skin oil-free; intermittent fasting; 
eating a good diet; an elimination diet where the indi- 
vidual avoids alcohol, dairy products, smoking, 
caffeine, sugar, processed foods, and foods high in io- 
dine, a mineral which appears to contribute to acne. 

Supplementation with herbs that are blood cleansers 
or blood purifiers is recommended. These herbs 
strengthen the action of the liver and the kidneys, help- 
ing with detoxification and excretion. Dandelion root 
tincture (Taraxacum officinale) is recommended. Others 
include burdock root ( Arctium lappa), also known as 
gobo, and can be purchased fresh at health food grocers 
or in Asian markets. It can be used either raw or cooked 
in salads, stir-fries, or other vegetable dishes. Burdock 
root tincture can also be used. Red clover ( Trifolium 
pratense) makes a pleasant tea that can be consumed 
throughout the day. Milk thistle seed (Silybum mari- 
anum) can either be taken in tincture form or the seeds 
can be ground up and eaten in combination with hot ce- 
real, granola, or other foods. 

Other herbs useful in the treatment of acne include 
Echinacea spp. and goldenseal (Hydrastis canadensis). 
Goldenseal is particularly helpful in clearing up underly- 
ing conditions of intestinal toxicity. Herbal remedies 
used in traditional Chinese medicine (TCM) for acne 
include cnidium seed, ( Cnidium monnieri), and honey- 
suckle flower ( Lonicera japonica). Supplementation nu- 
trients, such as essential fatty acids (EFAs), vitamin B 
complex, zinc, vitamin A or beta-carotene, and chromi- 
um are also recommended. 

Bowel toxicity may contribute to acne flare-ups, and 
should be addressed. Lactobacillus acidophilus and Lac- 
tobacillus bulgaricus should be taken in yogurt or in 
capsules to maintain a healthy balance of intestinal flora. 
Goldenseal can be used to kill toxic bacteria. Allergic 
foods should be identified and removed from the diet. 


Dietary fiber, such as oats and wheat bran, beans, fruits 
and vegetables and their skins, and psyllium seed, 
should be increased in the diet. The fiber will absorb tox- 
ins and carry them through the colon to be excreted. 

In addition, those with acne may want to participate 
in movement therapy, such as yoga or t’ai chi, or begin 
an exercise regimen. The person may also consider 
stress reduction or meditation. 

Allopathic treatment 

Acne treatment consists of reducing sebum and ker- 
atin production, encouraging the shedding of dead skin 
cells to help unclog the pores, and killing or limiting 
bacteria. Treatment choice depends upon whether the 
acne is mild, moderate, or severe. Complicated cases are 
referred to a dermatologist, or an endocrinologist, who 
treats diseases of the glands and the hormones. Counsel- 
ing may be necessary to clear up misconceptions about 
the condition and to offer support regarding the negative 
effect of acne on the physical appearance. 

Topical drugs 

Treatment for mild acne consists of reducing the 
formation of new comedones with over-the-counter acne 
medications containing benzoyl peroxide (e.g., Clearasil, 
Fostex), salicylic acid (Stridex), sulfur (Therac lotion), 
resorcinol (Acnomel cream). Treatment with stronger 
medications requires a doctor’s supervision. Such med- 
ications include comedolytics, which are agents that 
loosen hard plugs and open pores. Adapalene (Differin), 
the vitamin A acid tretinoin (Retin-A), and concentrated 
versions of salicylic acid, resorcinol, and sulfur are in 
this group. Topical antibiotics, such as erythromycin, 
clindamycin (Cleocin-T), and meclocycline (Meclan), 
may be added to the treatment regimen. Drugs that act as 
both comedolytics and antibiotics, such as benzoyl per- 
oxide, azelaic acid (Azelex), or benzoyl peroxide plus 
erythromycin (Benzamycin), are also used. 

After washing with a mild soap, the acne medica- 
tions are applied alone or in combination, once or twice 
a day over the entire affected area of skin. It may take 
many months to years to control the condition with these 
medications. Possible side effects include mild redness, 
peeling, irritation, dryness, and an increased sensitivity 
to sunlight that requires use of a sunscreen. 

Oral drugs 

When acne is severe and the lesions are deep, oral 
antibiotics may be taken daily to reduce the spread of 
bacteria. Tetracycline is the medication most often used. 
Minocycline, however, may be more preferable because 


it has fewer side effects. Erythromycin and doxycycline 
are also used, and they also have side effects, including 
dizziness, photosensitivity, gastrointestinal problems, 
and darkening of the skin. Other possible side effects in- 
clude allergic reactions, yeast infections, dizziness, 
tooth discoloration, and folliculitis. It is necessary for 
antibiotics to be used for up to three months to clear up 
the condition. 

Isotretinoin (Accutane) can be used in cases of very 
severe acne, or if antibiotic therapy proves unsuccessful. 
It may clear up resistant cysts and nodules in up to 90% 
of people and prevent scarring. Some do require a sec- 
ond course of treatment before this happens, however. 
Although the medication can be quite helpful, women 
who might become pregnant should use it with care. 
Isotretinoin can cause birth defects up to a month after it 
has stopped being used. Therefore, strict attention is paid 
to pregnancy tests and contraceptive requirements for 
women of child-bearing age who take this medication. 

The course of treatment with isotretinoin lasts about 
four to five months. If dosage is kept low, a longer 
course of therapy is needed. Isotretinoin is a strong med- 
ication. Side effects are very common, mostly dryness of 
the eyes, genital mucosa, and lips. Other effects may in- 
clude increases in cholesterol, tryglicerides, and abnor- 
mal liver enzymes. Blood tests taken each month should 
be monitored during the course of treatment to ensure 
that the medication is not causing serious harm. 

Anti-androgens, drugs that inhibit androgen produc- 
tion, are used to treat women who are unresponsive to 
other therapies. Oral contraceptives such as norgesti- 
mate/ethinyl estradiol (Ortho-Tri-Cyclen) have been 
shown to improve acne. In late 2001, a clinical trial 
demonstrated that ultra low-dose birth control pills 
(Alesse) prove as effective in treating acne as do pills 
with higher doses of estrogen. Improvement may take up 
to four months. 

Other drugs, such as spironolactone and corticos- 
teroids, may be used to reduce hormone activity in the 
adrenal glands, reducing production of sebum. This is 
the treatment of choice for an extremely severe, but rare 
type of acne called acne fulminans, found mostly in ado- 
lescent males. Acne conglobata, a more common form of 
severe inflammation, is characterized by numerous, 
deep, inflammatory nodules that heal with scarring. It is 
treated with oral isotretinoin and corticosteroids. 

Other types of treatment 

Several surgical or medical treatments are available 
to alleviate acne or the resulting scars: 

• Comedone extraction. The comedo is removed from 
the pore with a special tool. 




• Chemical peels. Glycolic acid is applied to peel off the 
top layer of skin to reduce scarring. 

• Dermabrasion. The affected skin is frozen with a chem- 
ical spray, and removed by brushing or planing. 

• Punch grafting. Deep scars are excised and the area re- 
paired with small skin grafts. 

• Intralesional injection. Corticosteroids are injected di- 
rectly into inflamed pimples. 

• Collagen injection. Shallow scars are elevated by colla- 
gen protein injections. 

• Laser treatments. Two types of laser treatments are proving 
effective in treating acne scars. Laser-treated skin heals in 
three to 10 days, depending on the treatment chosen. 

Expected results 

Most dermatologists now use a combination of ther- 
apies to treat acne, depending on the individual. Results 
of specific treatments will vary. Acne is not a serious 
health threat. The most troubling aspects of this condi- 
tion are the negative cosmetic effects and potential for 
permanent scarring. Some people, especially teenagers, 
become emotionally upset about their condition, and this 
may contribute to social or emotional problems. 

Acne is not considered curable, although it can be 
controlled by proper treatment, with improvement possi- 
bly taking many months. Acne tends to reappear when 
treatment stops, but it often spontaneously improves over 
time. Inflammatory acne may leave scars that require 
further treatment. 


There are no sure ways to prevent acne, but the fol- 
lowing steps may be taken to minimize flare-ups: 

• Gentle washing of affected areas once or twice every day. 

• Avoidance of abrasive cleansers. 

• Limited use of makeup and moisturizers; with avoid- 
ance of oil-based brands altogether. 

• Oily hair should be shampooed often and worn up, 
away from the face. 

• A healthy, well-balanced diet should be eaten. Fresh 
fruits and vegetables should be stressed, and foods that 
seem to trigger flare-ups should be avoided. 

• The face can be washed gently, twice daily with a soap 
compounded of sulfur. Calendula officinalis, or other 
substances that are useful against acne. 

• Affected areas should not be handled excessively. Pim- 
ples should not be squeezed or prodded, as this may con- 
tribute to scarring, as well as spreading the acne lesions. 



Androgens — Male sex hormones that are linked 
with the development of acne. 

Comedo — A hard plug composed of sebum and 
dead skin cells. 

Follicles — Structures where pimples form. They 
are found within the skin and house the oil glands 
and hair. 

Isotretinoin — A drug that decreases sebum pro- 
duction and dries up acne pimples. 

Sebum — An oily skin moisturizer produced by se- 
baceous glands. 

• Emotional stress should be kept in check. 



Murray, Michael, and Joseph Pizzorno. Encyclopedia of Natur- 
al Medicine. 2nd ed. California: Prima Publishing, 1998. 

Tierney Jr., Lawrence M., et at, eds. Current Medical Diagno- 
sis and Treatment 2003 . 42nd ed. Connecticut: Appleton 
& Lange, 2002. 


“Combination Therapies Offer New Management Options for 
Acne.” Medical Devices and Surgical Technology Week 
(December 9, 2001): 13. 

“Monthly Hormonal Changes in Menstrual Cyclel Affect 
Flare-ups.” Health and Medicine Week (December 31, 
2001): 4. 

“Ultra Low-Dose Estrogen Birth Control Pill is Effective Treat- 
ment.” Women's Health Weekly (October 4, 2001). 


Merck & Co., Inc. The Merck Manual Online. December 28, 
2000 [cited October 2002]. <>. 

Patience Paradox 

Acne rosacea see Rosacea 



Aconite is the common name for any of 100 or more 
related species in the Aconitum genus. Two of the 
species, Aconitum napellus and Aconitum carmichaeli 


are used medicinally. The more popular remedy, Aconi- 
tum napellus, is a plant that grows in mountainous re- 
gions of Central Asia, Russia, Europe, and Great Britain. 
This perennial plant from the Ranunculaceae family 
grows to a height of 3 ft (1 m) and has dark green, glossy 
leaves and dark blue flowers. 

Other names for aconite are wolf’s bane, monks- 
hood, blue rocket, and friar’s cap. Wolf’s bane is a direct 
translation of the Greek word Lycotonum. The Greeks 
left the plant as poisonous bait for wolves or anointed ar- 
rows with the juice of the herb in order to kill wolves. 
The plant was nicknamed monkshood and friar’s cap be- 
cause of the shape of the flowers. 

The plant in its fresh form is highly poisonous. The 
poison comes from the toxic alkaloid aconitine. Aconi- 
tine is found in the whole plant but is mainly concentrat- 
ed in the root. Symptoms of poisoning include tingling, 
numbness of the tongue and mouth, nausea and vomit- 
ing, labored breathing, a weak and irregular pulse, and 
cold, clammy skin. Even the smallest amounts of aconi- 
tine inside the mouth cause burning, tingling, and numb- 
ness. As little as 2 mg of aconitine can cause death in as 
little as 4 hours, which may be one reason why aconite is 
often chosen by people attempting suicide by poison. 
The Australian government has declared all species of 
aconite “unfit for human consumption.” 

General use 

Western herbology 

Herbalists have used aconite as a medicine for hun- 
dreds of years. However, in ancient times the herb was 
known more for its power to kill rather than heal; it was 
often used in ancient Rome to commit murders. 

The herb acts as a diuretic (a substance that pro- 
motes urination) and diaphoretic (a substance that causes 
sweating). Tinctures are taken internally to slow fevers, 
pneumonia, laryngitis, and acute tonsillitis. Liniments 
or ointments made from the herb are applied externally 
to relieve the pain of neuralgia and rheumatism. 

Traditional Chinese medicine 

Aconitum carmichaeli is used in traditional Chi- 
nese medicine. It is called Fu Zi (sometimes Fu Tzu) in 
Mandarin; in other parts of China and in Hong Kong it is 
known as chuan won ton.. This herb is used to treat 
rheumatism, bruises, arthritis, acute hypothermia, diar- 
rhea, and impotence. The herb is very hot and has a 
sweet, spicy taste. 

The main function of Fu Zi is to warm the interior. It 
also works to restore collapsed yang, warm Kidney fire, 
warm the Kidney and Spleen, drive out the cold, warm 


the meridians, and relieve pain. Fu Zi is also used by tra- 
ditional Chinese herbalists in conditions marked by defi- 
cient Kidney and Spleen yang or in conditions with early 
morning diarrhea or lack of appetite. 

Aconitum carmichaeli also contains the toxic alka- 
loid aconitine. After cooking the herb, the alkaloid is 
converted to aconine, which is not as toxic. 

This herb is poisonous. When it is properly prepared 
as recommended by a Chinese medicine practitioner, 
there are rarely any adverse effects. Chinese pharmacies 
do not sell raw, untreated aconite, as the plant should be 
dried and then brewed for long periods of time. There 
have been, however, cases of aconite poisoning reported 
in Asian countries, including some that ended in the pa- 
tient’s death from heart arrhythmias. It appears that most 
of these cases are due either to the herbalist’s prescribing 
a larger dose of aconite than is needed, or to the patient’s 
attempting to prepare the remedy at home. 


Homeopaths prescribe aconite for conditions that 
come on suddenly as a result of grief, fear, anger, shock, 
or exposure to cold, dry wind. It is also recommended for 
people troubled by suicidal thoughts. The remedy is short- 
acting and is indicated at the onset of acute conditions 
such as croup, colds, cough, bronchitis, eye and ear in- 
fections, headaches, and rheumatism. This remedy is one 
of the best for measles, arthritis, and pneumonia when all 
of the symptoms are present. Aconite is also useful at the 
beginning of a fever, in early stages of inflammation, and 
following shock caused by an injury or surgery. 


Aconite is available as a homeopathic remedy or in 
dried bulk form, as an ointment or liniment, and as a 
tincture. Pharmacies, health food stores, and Chinese 
herbal stores carry the various preparations. They are 
also available as prescribed by a herbalist, homeopathic 
doctor, or Chinese medicine practitioner. 

The whole plant is used in Western herbal medicine. 
The leaves and flowers are cut when the flowers are in 
blossom in June. The roots are collected after the stem 
has died off, usually in August. The root is dried before 
use while the leaves, stems, and flowers are used fresh. 

The homeopathic preparation of aconite is created in 
the following manner. The whole plant — but not the 
root — is collected when the flowers are in full bloom and 
pounded to a pulp. The juice from the pulp is pressed 
and mixed with alcohol. The mixture is then strained and 
diluted. The final homeopathic remedy is created after 
the diluted mixture is repeatedly succussed (pounded 




against a hard surface to break down and mix the sub- 
stance). The remedy is available at health-food and drug 
stores in various potencies in the form of tinctures, 
tablets, and pellets. 

In traditional Chinese medicine, the aconite root is 
generally used in small amounts in combination with 
other herbs. 


If symptoms do not improve after the recommended 
time period, consult your homeopath or other healthcare 

Do not exceed the recommended dosage. 

Use Aconitum carmichaeli only under supervision 
of a Chinese medical practitioner. 

Aconite is poisonous and should not be consumed in 
its raw state. Persons who gather wild plants to eat 
should be very careful in identifying what they are gath- 
ering; cases have been reported of aconite poisoning in 
people who thought they were gathering “mountain 

Women who are pregnant, trying to get pregnant, or 
who are breast-feeding should not use Aconitum car- 

Side effects 

Symptoms of poisoning by the fresh aconite plant 
include tingling, numbness of the tongue and mouth, 
nausea, vomiting, labored breathing, a weak and irregu- 
lar pulse, and cold, clammy skin. In cases of severe poi- 
soning, aconite can produce extreme symptoms that in- 
clude severe pain, convulsions, paralysis, confusion, 
seizures, and heart failure. The only established treat- 
ment for aconite poisoning is supportive; that is, there is 
no antidote. 

Most liniments or lotions made with aconite for ex- 
ternal use contain a 1.3% concentration of the herb. Use 
of these preparations must be limited to unbroken skin, 
as aconite can be absorbed through the skin and cause 
toxic symptoms. If a skin reaction occurs, use of the lini- 
ment must be discontinued immediately. 


When taking any homeopathic remedy, do not use 
peppermint products, coffee, or alcohol. These products 
will make the remedy ineffective. 

Aconitum carmichaeli should not be used in those 
having a deficiency of yin, or coolness, or with signs of 
heat such as fever, redness, and agitation. 



Aconitine — A toxic alkaloid contained in aconite. 
As little as 2 mg taken internally may be fatal. 

Antidote — A medication or remedy given to coun- 
teract the effects of a poison. 

Diaphoretic — A substance that causes sweating. 
Diuretic — A substance that promotes urination. 
Succussion — A process integral to the creation of 
a homeopathic remedy in which a solution is re- 
peatedly struck against a firm surface. This is per- 
formed to thoroughly mix the substance and mag- 
nify its healing properties. 

Toxicology — The branch of medical pharmacolo- 
gy dealing with the detection, effects, and anti- 
dotes of poisons. 



Cummings, Stephen, M.D., and Dana Ullman. Everybody' s 
Guide to Homeopathic Medicines. New York: Putnam, 

Kent, James Tyler. Lectures on Materia Medica. Delhi, India: 
B. Jain Publishers, 1996. 

Reid, Daniel. Chinese Herbal Medicine. Boston, MA: Shamb- 
hala, 1996. 


Chan, T. Y. "Incidence of Herb-Induced Aconitine Poisoning in 
Hong Kong: Impact of Publicity Measures to Promote 
Awareness Among the Herbalists and the Public.” Drug 
Safety 25 (2002): 823-828. 

Elliott, S. P. “A Case of Fatal Poisoning with the Aconite Plant: 
Quantitative Analysis in Biological Fluid.” Science and 
Justice 42 (April-June 2002): 111-115. 

Gaibazzi, N., G. P. Gelmini, G. Montresor, et al. “Case Study 
of Accidental Aconite Poisoning.” [in Italian] Italian 
Heart Journal 3 (August 2002): 874-877. 


American Academy of Clinical Toxicology. Ill East Park 
Drive, P. O. Box 8820, Harrisburg, PA 17105. (717) 558- 
7750. <>. 

National Center for Homeopathy. 801 N. Fairfax St., Suite 306, 
Alexandria, VA 22314. (703) 548-7790. 

Jennifer Wurges 
Rebecca J. Frey, PhD 

Acquired Immunodeficiency syndrome see 





Acupressure is a form of touch therapy that utilizes 
the principles of acupuncture and Chinese medicine. In 
acupressure, the same points on the body are used as in 
acupuncture, but are stimulated with finger pressure in- 
stead of with the insertion of needles. Acupressure is 
used to relieve a variety of symptoms and pain. 


One of the oldest text of Chinese medicine is the 
Huang Di, The Yellow Emperor’s Classic of Internal 
Medicine, which may be at least 2,000 years old. Chinese 
medicine has developed acupuncture, acupressure, herbal 
remedies, diet, exercise, lifestyle changes, and other 
remedies as part of its healing methods. Nearly all of the 
forms of Oriental medicine that are used in the West 
today, including acupuncture, acupressure, shiatsu, and 
Chinese herbal medicine, have their roots in Chinese 
medicine. One legend has it that acupuncture and acu- 
pressure evolved as early Chinese healers studied the 
puncture wounds of Chinese warriors, noting that certain 
points on the body created interesting results when stimu- 
lated. The oldest known text specifically on acupuncture 
points, the Systematic Classic of Acupuncture , dates back 
to 282 a.d. Acupressure is the non-invasive form of 
acupuncture, as Chinese physicians determined that stim- 
ulating points on the body with massage and pressure 
could be effective for treating certain problems. 

Outside of Asian- American communities, Chinese 
medicine remained virtually unknown in the United 
States until the 1970s, when Richard Nixon became the 
first U.S. president to visit China. On Nixon’s trip, jour- 
nalists were amazed to observe major operations being 
performed on patients without the use of anesthetics. In- 
stead, wide-awake patients were being operated on, with 
only acupuncture needles inserted into them to control 
pain. At that time, a famous columnist for the New York 
Times, James Reston, had to undergo surgery and elected 
to use acupuncture for anesthesia. Later, he wrote some 
convincing stories on its effectiveness. Despite being ne- 
glected by mainstream medicine and the American Med- 
ical Association (AMA), acupuncture and Chinese medi- 
cine became a central to alternative medicine practition- 
ers in the United States. Today, there are millions of pa- 
tients who attest to its effectiveness, and nearly 9,000 
practitioners in all 50 states. 

Acupressure is practiced as a treatment by Chinese 
medicine practitioners and acupuncturists, as well as by 
massage therapists. Most massage schools in American 


include acupressure techniques as part of their bodywork 
programs. Shiatsu massage is very closely related to acu- 
pressure, working with the same points on the body and 
the same general principles, although it was developed 
over centuries in Japan rather than in China. Reflexology 
is a form of bodywork based on acupressure concepts. 
Jin Shin Do is a bodywork technique with an increasing 
number of practitioners in America that combines acu- 
pressure and shiatsu principles with qigong, Reichian 
theory, and meditation. 


Acupressure massage performed by a therapist can 
be very effective both as prevention and as a treatment 
for many health conditions, including headaches, general 
aches and pains, colds and flu, arthritis, allergies, asth- 
ma, nervous tension, menstrual cramps, sinus problems, 
sprains, tennis elbow, and toothaches, among others. 
Unlike acupuncture which requires a visit to a profes- 
sional, acupressure can be performed by a layperson. 
Acupressure techniques are fairly easy to learn, and have 
been used to provide quick, cost-free, and effective relief 
from many symptoms. Acupressure points can also be 
stimulated to increase energy and feelings of well-being, 
reduce stress, stimulate the immune system, and allevi- 
ate sexual dysfunction. 


Acupressure and Chinese medicine 

Chinese medicine views the body as a small part of 
the universe, subject to laws and principles of harmony 
and balance. Chinese medicine does not make as sharp a 
destinction as Western medicine does between mind and 
body. The Chinese system believes that emotions and 
mental states are every bit as influential on disease as 
purely physical mechanisms, and considers factors like 
work, environment, and relationships as fundamental to a 
patient’s health. Chinese medicine also uses very different 
symbols and ideas to discuss the body and health. While 
Western medicine typically describes health as mainly 
physical processes composed of chemical equations and 
reactions, the Chinese use ideas like yin and yang, chi, and 
the organ system to describe health and the body. 

Everything in the universe has properties of yin and 
yang. Yin is associated with cold, female, passive, down- 
ward, inward, dark, wet. Yang can be described as hot, 
male, active, upward, outward, light, dry, and so on. 
Nothing is either completely yin or yang. These two 
principles always interact and affect each other, although 
the body and its organs can become imbalanced by hav- 
ing either too much or too little of either. 




Therapist working acupressure points on a woman’s shoulder. (Photo Researchers, Inc. Reproduced by permission.) 

Chi (pronounced chee, also spelled qi or ki in Japan- 
ese shiatsu) is the fundamental life energy. It is found in 
food, air, water, and sunlight, and it travels through the 
body in channels called meridians. There are 12 major 
meridians in the body that transport chi, corresponding 
to the 12 main organs categorized by Chinese medicine. 

Disease is viewed as an imbalance of the organs and 
chi in the body. Chinese medicine has developed intri- 
cate systems of how organs are related to physical and 
mental symptoms, and it has devised corresponding 
treatments using the meridian and pressure point net- 
works that are classified and numbered. The goal of acu- 
pressure, and acupuncture, is to stimulate and unblock 
the circulation of chi, by activating very specific points, 
called pressure points or acupoints. Acupressure seeks to 
stimulate the points on the chi meridians that pass close 
to the skin, as these are easiest to unblock and manipu- 
late with finger pressure. 

Acupressure can be used as part of a Chinese physi- 
cian’s prescription, as a session of massage therapy, or 
as a self-treatment for common aches and illnesses. A 
Chinese medicine practitioner examines a patient very 
thoroughly, looking at physical, mental and emotional ac- 


tivity, taking the pulse usually at the wrists, examining 
the tongue and complexion, and observing the patient’s 
demeanor and attitude, to get a complete diagnosis of 
which organs and meridian points are out of balance. 
When the imbalance is located, the physician will recom- 
mend specific pressure points for acupuncture or acupres- 
sure. If acupressure is recommended, the patient might 
opt for a series of treatments from a massage therapist. 

In massage therapy, acupressurists will evaluate a 
patient’s symptoms and overall health, but a massage 
therapist’s diagnostic training isn’t as extensive as a Chi- 
nese physician’s. In a massage therapy treatment, a per- 
son usually lies down on a table or mat, with thin cloth- 
ing on. The acupressurist will gently feel and palpate the 
abdomen and other parts of the body to determine energy 
imbalances. Then, the therapist will work with different 
meridians throughout the body, depending on which or- 
gans are imbalanced in the abdomen. The therapist will 
use different types of finger movements and pressure on 
different acupoints, depending on whether the chi needs 
to be increased or dispersed at different points. The ther- 
apist observes and guides the energy flow through the 
patient’s body throughout the session. Sometimes, spe- 
cial herbs ( Artemesia vulgaris or moxa) may be placed 


on a point to warm it, a process called moxibustion. A 
session of acupressure is generally a very pleasant expe- 
rience, and some people experience great benefit imme- 
diately. For more chronic conditions, several sessions 
may be necessary to relieve and improve conditions. 

Acupressure massage usually costs from $30-70 per 
hour session. A visit to a Chinese medicine physician or 
acupuncturist can be more expensive, comparable to a 
visit to an allopathic physician if the practitioner is an 
MD. Insurance reimbursement varies widely, and con- 
sumers should be aware if their policies cover alternative 
treatment, acupuncture, or massage therapy. 


Acupressure is easy to learn, and there are many 
good books that illustrate the position of acupoints and 
meridians on the body. It is also very versatile, as it can 
be done anywhere, and it’s a good form of treatment for 
spouses and partners to give to each other and for parents 
to perform on children for minor conditions. 

While giving self-treatment or performing acupres- 
sure on another, a mental attitude of calmness and atten- 
tion is important, as one person’s energy can be used to 
help another’s. Loose, thin clothing is recommended. 
There are three general techniques for stimulating a pres- 
sure point. 

• Tonifying is meant to strengthen weak chi, and is done 
by pressing the thumb or finger into an acupoint with a 
firm, steady pressure, holding it for up to two minutes. 

• Dispersing is meant to move stagnant or blocked chi, 
and the finger or thumb is moved in a circular motion 
or slightly in and out of the point for two minutes. 

• Calming the chi in a pressure point utilizes the palm to 
cover the point and gently stroke the area for about two 

There are many pressure points that are easily found 
and memorized to treat common ailments from 
headaches to colds. 

• For headaches, toothaches, sinus problems, and pain in 
the upper body, the “LI4” point is recommended. It is 
located in the web between the thumb and index finger, 
on the back of the hand. Using the thumb and index fin- 
ger of the other hand, apply a pinching pressure until 
the point is felt, and hold it for two minutes. Pregnant 
women should never press this point. 

• To calm the nerves and stimulate digestion, find the 
“CV12” point that is four thumb widths above the 
navel in the center of the abdomen. Calm the point with 
the palm, using gentle stroking for several minutes. 

Press on point governing vessel 24.5, the top of the bridge 
of the nose, lightly for two minutes to relieve hay fever 
symptoms. Press on lung 10, the center of the thumb pad, 
for one minute to alleviate a sore throat. To ease heartburn, 
apply pressure to stomach 36, four finger-widths below the 
kneecap outside the shinbone. Use on both legs. (Illustra- 
tion by Electronic Illustrators Group. The Gale Group.) 





Press on point pericardium 6 for one minute on each arm to 
relieve general nausea. Press on stomach 3, at the bottom 
of the cheekbones, to relieve a sinus headache. Squeezing 
the webbed area between your forefinger and thumb, large 
intestine 4, may also help relieve sinus pain. (Illustration by 
Electronic Illustrators Group. The Gale Group.) 

• To stimulate the immune system, find the “TH5” point 
on the back of the forearm two thumb widths above the 
wrist. Use a dispersing technique, or circular pressure 
with the thumb or finger, for two minutes on each arm. 

• For headaches, sinus congestion, and tension, locate 
the “GB20” points at the base of the skull in the back 
of the head, just behind the bones in back of the ears. 
Disperse these points for two minutes with the fingers 
or thumbs. Also find the “yintang” point, which is in 
the middle of the forehead between the eyebrows. Dis- 
perse it with gentle pressure for two minutes to clear 
the mind and to relieve headaches. 


Acupressure is a safe technique, but it is not meant 
to replace professional health care. A physician should 
always be consulted when there are doubts about med- 
ical conditions. If a condition is chronic, a professional 
should be consulted; purely symptomatic treatment 
can exacerbate chronic conditions. Acupressure should 
not be applied to open wounds, or where there is 
swelling and inflammation. Areas of scar tissue, blis- 
ters, boils, rashes, or varicose veins should be avoid- 
ed. Finally, certain acupressure points should not be 
stimulated on people with high or low blood pressure 
and on pregnant women. 

Research & general acceptance 

In general, Chinese medicine has been slow to gain 
acceptance in the West, mainly because it rests on ideas 
very foreign to the scientific model. For instance, West- 
ern scientists have trouble with the idea of chi, the invisi- 
ble energy of the body, and the idea that pressing on cer- 
tain points can alleviate certain conditions seems some- 
times too simple for scientists to believe. 

Western scientists, in trying to account for the action 
of acupressure, have theorized that chi is actually part of 
the neuroendocrine system of the body. Celebrated or- 
thopedic surgeon Robert O. Becker, who was twice nom- 
inated for the Nobel Prize, wrote a book on the subject 
called Cross Currents: The Promise of Electromedicine ; 
The Perils of Electropollution. By using precise electri- 
cal measuring devices, Becker and his colleagues 
showed that the body has a complex web of electromag- 
netic energy, and that traditional acupressure meridians 
and points contained amounts of energy that non-acu- 
pressure points did not. 

The mechanisms of acupuncture and acupressure re- 
main difficult to document in terms of the biochemical 
processes involved; numerous testimonials are the pri- 
mary evidence backing up the effectiveness of acupres- 



sure and acupuncture. However, a body of research is 
growing that verifies the effectiveness in acupressure and 
acupuncture techniques in treating many problems and 
in controlling pain. 

Training & certification 

There are two routes to becoming trained in the skill 
of acupressure. The first is training in traditional 
acupuncture and Chinese medicine, which has many 
schools and certifying bodies around the country. The 
majority of acupressure practitioners are trained as certi- 
fied massage therapists, either as acupressure or shiatsu 

The Acupressure Institute provides certification and 
resources for acupressure practitioners. Address: 1533 
Shattuck Ave., Berkeley, CA 94709, (800) 442-2232 or 
(510) 845-1059, 

The American Oriental Bodywork Therapy Associa- 
tion (AOBTA) certifies acupressure practitioners and has 
over 1,400 members. It also provides a list of schools and 
training programs. Address: 1010 Haddonfield-Berlin 
Road, Suite 408, Voorhees, NJ 08043, phone (856) 782- 
1616, email: ttp://222. 

The Jin Shin Do Foundation for Body/Mind Acu- 
pressure is an international network of teachers and prac- 
titioners. Address: RO. Box 416, Idyllwild, CA 92549. 
phone: (909) 659-5707 

The largest organization that certifies massage ther- 
apists, with over 40,000 members worldwide, is the 
American Massage Therapy Association. It also has a 
member directory and lists of training programs. Web- 



Jarmey, Chris and John Tindall. Acupressure for Common Ail- 
ments. London: Gaia, 1991. 

Kakptchuk, Ted. The Web That Has No Weaver: Understanding 
Chinese Medicine. New York: Congdon and Weed, 1983. 
Warren, Frank Z., MD. Freedom From Pain Through Acupres- 
sure. New York: Fell, 1976. 


Massage Therapy Journal. 820 Davis Street, Suite 100, 
Evanston, IL 60201-4444. 


American Association of Oriental Medicine, http://www.aaom. 
org/ (December 28, 2000). 

National Acupuncture and Oriental Medicine Alliance, http:// (December 28, 2000). 

Douglas Dupler 



Acupoint — A pressure point stimulated in acu- 

Chi — Basic life energy. 

Meridian — A channel through which chi travels in 
the body. 

Moxibustion — An acupuncture technique that 
burns the herb moxa or mugwort. 

Shiatsu — Japanese form of acupressure massage. 

Yin/yang — Universal characteristics used to de- 
scribe aspects of the natural world. 



Acupuncture is one of the main forms of treatment in 
traditional Chinese medicine. It involves the use of sharp, 
thin needles that are inserted in the body at very specific 
points. This process is believed to adjust and alter the 
body’s energy flow into healthier patterns, and is used to 
treat a wide variety of illnesses and health conditions. 


The original text of Chinese medicine is the Nei 
Ching, The Yellow Emperor’s Classic of Internal Medi- 
cine , which is estimated to be at least 2,500 years old. 
Thousands of books since then have been written on the 
subject of Chinese healing, and its basic philosophies 
spread long ago to other Asian civilizations. Nearly all of 
the forms of Oriental medicine which are used in the 
West today, including acupuncture, shiatsu, acupressure 
massage, and macrobiotics, are part of or have their roots 
in Chinese medicine. Legend has it that acupuncture de- 
veloped when early Chinese physicians observed unpre- 
dicted effects of puncture wounds in Chinese warriors. 
The oldest known text on acupuncture, the Systematic 
Classic of Acupuncture , dates back to 282 a.d. Although 
acupuncture is its best known technique, Chinese medi- 
cine traditionally utilizes herbal remedies, dietary thera- 
py, lifestyle changes and other means to treat patients. 

In the early 1900s, only a few Western physicians 
who had visited China were fascinated by acupuncture, 
but outside of Asian- American communities it remained 
virtually unknown until the 1970s, when Richard Nixon 
became the first U.S. president to visit China. On Nixon's 
trip, journalists were amazed to observe major operations 




Woman undergoing facial acupuncture. (Photograph by Yoav Levy. Phototake NYC. Reproduced by permission.) 

being performed on patients without the use of anesthet- 
ics. Instead, wide-awake patients were being operated on 
with only acupuncture needles inserted into them to con- 
trol pain. During that time, a famous columnist for the 
New York Times, James Reston, had to undergo surgery 
and elected to use acupuncture instead of pain medication, 
and he wrote some convincing stories on its effectiveness. 

Today acupuncture is being practiced in all 50 states 
by more than 9,000 practitioners, with about 4,000 MDs 
including it in their practices. Acupuncture has shown no- 
table success in treating many conditions, and more than 

15 million Americans have used it as a therapy. Acupunc- 
ture, however, remains largely unsupported by the med- 
ical establishment. The American Medical Association 
has been resistant to researching it, as it is based on con- 
cepts very different from the Western scientific model. 

Several forms of acupuncture are being used today 
in America. Japanese acupuncture uses extremely thin 
needles and does not incorporate herbal medicine in its 
practice. Auricular acupuncture uses acupuncture points 
only on the ear, which are believed to stimulate and bal- 
ance internal organs. In France, where acupuncture is 
very popular and more accepted by the medical estab- 
lishment, neurologist Paul Nogier developed a system of 


acupuncture based on neuroendocrine theory rather than 
on traditional Chinese concepts, which is gaining some 
use in America. 


The World Health Organization (WHO) recom- 
mends acupuncture as an effective treatment for over 
forty medical problems, including allergies, respiratory 
conditions, gastrointestinal disorders, gynecological 
problems, nervous conditions, and disorders of the eyes, 
nose and throat, and childhood illnesses, among others. 
Acupuncture has been used in the treatment of alco- 
holism and substance abuse. In 2002, a center in Maine 
received a unique grant to study acupuncture treatment 
for substance abuse. Although recognizing that acupunc- 
ture had been used before for helping those with abuse, 
this study sought to show that ear acupuncture’s effects 
on relaxation response helped those abusing drugs and 
alcohol better deal with the anxiety and life circum- 
stances thought to lead them to substance abuse. 

Acupuncture is an effective and low-cost treatment 
for headaches and chronic pain, associated with prob- 
lems like back injuries and arthritis. It has also been used 


Traditional Chinese medicine teachings state that channels of energy flow throughout the body, and that disease is caused 
by too much or to little flow of energy along these channels. Points along the channels, called meridians, are manipulated in 
acupuncture. In the illustration, points are shown on the bladder (BL), conception vessel (CV), gall bladder (GB), governing 
vessel (GV), heart (HE), kidney (Kl) large intestine (LI), liver (LV), lung (LU), pericardium (PE), small intestine (SI), spleen (SP), 
stomach (ST), and triple warmer (TW) meridians. (Illustration by Electronic Illustrators Group. The Gale Group.) 





to supplement invasive Western treatments like 
chemotherapy and surgery. Acupuncture is generally 
most effective when used as prevention or before a 
health condition becomes acute, but it has been used to 
help patients suffering from cancer and AIDS. In 2002, 
the National Institutes of health announced that pain 
from certain musculoskeletal conditions like fibromyal- 
gia could be helped by acupuncture. Acupuncture is lim- 
ited in treating conditions or traumas that require surgery 
or emergency care (such as for broken bones). 


Basic ideas of Chinese medicine 

Chinese medicine views the body as a small part of the 
universe, and subject to universal laws and principles of har- 
mony and balance. Chinese medicine does not draw a sharp 
line, as Western medicine does, between mind and body. 
The Chinese system believes that emotions and mental states 
are every bit as influential on disease as purely physical 
mechanisms, and considers factors like work, environment, 
lifestyle, and relationships as fundamental to the overall pic- 
ture of a patient’s health. Chinese medicine also uses very 
different symbols and ideas to discuss the body and health. 
While Western medicine typically describes health in terms 
of measurable physical processes made up of chemical reac- 
tions, the Chinese use ideas like yin and yang, chi, the organ 
system, and the five elements to describe health and the 
body. To understand the ideas behind acupuncture, it is 
worthwhile to introduce some of these basic terms. 

YIN AND YANG. According to Chinese philosophy, 
the universe and the body can be described by two sepa- 
rate but complementary principles, that of yin and yang. 
For example, in temperature, yin is cold and yang is hot. 
In gender, yin is female and yang is male. In activity, yin 
is passive and yang is active. In light, yin is dark and 
yang is bright; in direction yin is inward and downward 
and yang is outward and up, and so on. Nothing is ever 
completely yin or yang, but a combination of the two. 
These two principles are always interacting, opposing, 
and influencing each other. The goal of Chinese medi- 
cine is not to eliminate either yin or yang, but to allow 
the two to balance each other and exist harmoniously to- 
gether. For instance, if a person suffers from symptoms 
of high blood pressure, the Chinese system would say 
that the heart organ might have too much yang, and 
would recommend methods either to reduce the yang or 
to increase the yin of the heart, depending on the other 
symptoms and organs in the body. Thus, acupuncture 
therapies seek to either increase or reduce yang, or in- 
crease or reduce yin in particular regions of the body. 

CHI. Another fundamental concept of Chinese medi- 
cine is that of chi (pronounced chee. also spelled qi ). Chi 


is the fundamental life energy of the universe. It is invisi- 
ble and is found in the environment in the air, water, food 
and sunlight. In the body, it is the invisible vital force that 
creates and animates life. We are all born with inherited 
amounts of chi, and we also get acquired chi from the 
food we eat and the air we breathe. The level and quality 
of a person’s chi also depends on the state of physical, 
mental and emotional balance. Chi travels through the 
body along channels called meridians. 

THE ORGAN SYSTEM. In the Chinese system, there 
are twelve main organs: the lung, large intestine, stom- 
ach, spleen, heart, small intestine, urinary bladder, kid- 
ney, liver, gallbladder, pericardium, and the “triple 
warmer,” which represents the entire torso region. Each 
organ has chi energy associated with it, and each organ 
interacts with particular emotions on the mental level. As 
there are twelve organs, there are twelve types of chi 
which can move through the body, and these move 
through twelve main channels or meridians. Chinese 
doctors connect symptoms to organs. That is, symptoms 
are caused by yin/yang imbalances in one or more or- 
gans, or by an unhealthy flow of chi to or from one organ 
to another. Each organ has a different profile of symp- 
toms it can manifest. 

THE FIVE ELEMENTS. Another basis of Chinese theo- 
ry is that the world and body are made up of five main 
elements: wood, fire, earth, metal, and water. These ele- 
ments are all interconnected, and each element either 
generates or controls another element. For instance, 
water controls fire and earth generates metal. Each organ 
is associated with one of the five elements. The Chinese 
system uses elements and organs to describe and treat 
conditions. For instance, the kidney is associated with 
water and the heart is associated with fire, and the two 
organs are related as water and fire are related. If the kid- 
ney is weak, then there might be a corresponding fire 
problem in the heart, so treatment might be made by 
acupuncture or herbs to cool the heart system and/or in- 
crease energy in the kidney system. 

The Chinese have developed an intricate system of 
how organs and elements are related to physical and men- 
tal symptoms, and the above example is a very simple one. 
Although this system sounds suspect to Western scientists, 
some interesting parallels have been observed. For in- 
stance, Western medicine has observed that with severe 
heart problems, kidney failure often follows, but it still 
does not know exactly why. In Chinese medicine, this con- 
nection between the two organs has long been established. 

nese medicine, disease as seen as imbalances in the 
organ system or chi meridians, and the goal of any reme- 
dy or treatment is to assist the body in reestablishing its 


innate harmony. Disease can be caused by internal fac- 
tors like emotions, external factors like the environment 
and weather, and other factors like injuries, trauma, diet, 
and germs. However, infection is seen not as primarily a 
problem with germs and viruses, but as a weakness in 
the energy of the body that is allowing a sickness to 
occur. In Chinese medicine, no two illnesses are ever the 
same, as each body has its own characteristics of symp- 
toms and balance. Acupuncture is used to open or adjust 
the flow of chi throughout the organ system, which will 
strengthen the body and prompt it to heal itself. 

acupuncturist will do is get a thorough idea of a patient’s 
medical history and symptoms, both physical and emo- 
tional. This is done with a long questionnaire and inter- 
view. Then the acupuncturist will examine the patient to 
find further symptoms, looking closely at the tongue, the 
pulse at various points in the body, the complexion, gen- 
eral behavior, and other signs like coughs or pains. From 
this, the practitioner will be able to determine patterns of 
symptoms which indicate which organs and areas are 
imbalanced. Depending on the problem, the acupunctur- 
ist will insert needles to manipulate chi on one or more 
of the twelve organ meridians. On these twelve meridi- 
ans, there are nearly 2,000 points that can be used in 
acupuncture, with around 200 points being most fre- 
quently used by traditional acupuncturists. During an in- 
dividual treatment, one to 20 needles may be used, de- 
pending on which meridian points are chosen. 

Acupuncture needles are always sterilized and 
acupuncture is a very safe procedure. The depth of inser- 
tion of needles varies, depending on which chi channels 
are being treated. Some points barely go beyond superfi- 
cial layers of skin, while some acupuncture points re- 
quire a depth of 1-3 in (2. 5-7. 5 cm) of needle. The nee- 
dles generally do not cause pain. Patients sometimes re- 
port pinching sensations and often pleasant sensations, 
as the body experiences healing. Depending on the prob- 
lem, the acupuncturist might spin or move the needles, 
or even pass a slight electrical current through some of 
them. Moxibustion may be sometimes used, in which an 
herbal mixture (moxa or mugwort) is either burned like 
incense on the acupuncture point or on the end of the 
needle, which is believed to stimulate chi in a particular 
way. Also, acupuncturists sometimes use cupping, dur- 
ing which small suction cups are placed on meridian 
points to stimulate them. 

How long the needles are inserted also varies. Some 
patients only require a quick in and out insertion to clear 
problems and provide tonification (strengthening of 
health), while some other conditions might require nee- 
dles inserted up to an hour or more. The average visit to 
an acupuncturist takes about 30 minutes. The number of 


visits to the acupuncturist varies as well, with some con- 
ditions improved in one or two sessions and others re- 
quiring a series of six or more visits over the course of 
weeks or months. 

Costs for acupuncture can vary, depending on 
whether the practitioner is an MD. Initial visits with non- 
MD acupuncturists can run from $50-$100, with follow- 
up visits usually costing less. Insurance reimbursement 
also varies widely, depending on the company and state. 
Regulations have been changing often. Some states au- 
thorize Medicaid to cover acupuncture for certain condi- 
tions, and some states have mandated that general cover- 
age pay for acupuncture. Consumers should be aware of 
the provisions for acupuncture in their individual policies. 


Acupuncture is generally a very safe procedure. If a 
patient is in doubt about a medical condition, more than 
one physician should be consulted. Also, a patient should 
always feel comfortable and confident that their 
acupuncturist is knowledgable and properly trained. 

Research & general acceptance 

Mainstream medicine has been slow to accept 
acupuncture; although more MDs are using the technique, 
the American Medical Association does not recognize it as 
a specialty. The reason for this is that the mechanism of 
acupuncture is difficult to scientifically understand or 
measure, such as the invisible energy of chi in the body. 
Western medicine, admitting that acupuncture works in 
many cases, has theorized that the energy meridians are 
actually part of the nervous system and that acupuncture 
relieves pain by releasing endorphins, or natural pain 
killers, into the bloodstream. Despite the ambiguity in the 
biochemistry involved, acupuncture continues to show ef- 
fectiveness in clinical tests, from reducing pain to alleviat- 
ing the symptoms of chronic illnesses, and research in 
acupuncture is currently growing. The Office of Alterna- 
tive Medicine of the National Institute of Health is cur- 
rently funding research in the use of acupuncture for treat- 
ing depression and attention-deficit disorder. 

Training & certification 

Medical acupuncture has evolved in America which 
uses traditional methods mainly as surgical techniques 
and pain management, and not as part of Chinese medi- 
cine overall. Medical acupuncture is performed by an 
MD or an osteopathic physician (DO). Currently 23 
states allow only this type of acupuncture. Practitioners 
get their training as part of conventional medical school 
programs. As any MD can legally perform acupuncture, 





Acupressure — Form of massage using acupunc- 
ture points. 

Auricular acupuncture — Acupuncture using only 
points found on the ears. 

Chi — Basic life energy. 

Meridian — Channel through which chi travels in 
the body. 

Moxibustion — Acupuncture technique which 
burns the herb moxa or mugwort. 

Tonification — Acupuncture technique for 

strengthening the body. 

Yin/Yang — Universal characteristics used to de- 
scribe aspects of the natural world. 

The American Academy of Medical Acupuncture 
(AAMA) was chartered in 1987 to support the education 
and correct practice of physician-trained acupuncturists. 
Its members must be either MDs or DOs who have com- 
pleted proper study of acupuncture techniques. Address: 
5820 Wilshire Blvd., Suite 500, Los Angeles, CA 90036, 
(323) 937-5514, 

For traditional acupuncturists. The National Com- 
mission for Certification of Acupuncturists (NCCA) con- 
ducts certification exams, promotes national standards, 
and registers members. Most states that license acupunc- 
turists use the NCCA standards as certification. Address: 
11 Canal Center Plaza, Ste. 300, Alexandra, VA 22314, 
(703) 548-9004, 

The American Association of Acupuncture and Ori- 
ental Medicine (AAAOM) is the largest organization for 
practitioners, with more than 1,600 members. Address: 
1925 W. County Rd B2, Roseville, MN 55113, (651) 631- 



Fleischman, Dr. Gary F. Acupuncture: Everything You Ever 
Wanted To Know. New York: Barrytown, 1998. 

Kakptchuk, Ted. The Web That Has No Weaver: Understanding 
Chinese Medicine. New York: Congdon and Weed, 1983. 
Requena, Yves, MD. Terrains and Pathology in Acupuncture. 
Massachusetts: Paradigm, 1986. 


American Journal of Acupuncture. 1840 41st Ave., Suite 102, 
P.O. Box 610, Capitola, CA 95010. 

Assefi, Nassim. “Acupuncture for Fibromyalgia.” Alternative 
Medicine Alert. (February 2002): 13. 


Savage, Lorraine. “Grant to Study Acupuncture”s Effective- 
ness on Patients Suffering from Substance Abuse.” 
Healthcare Review. (March 19, 2002): 16. 


American Association of Oriental Medicine, http://www.aaom. 
org / (December 28, 2000). 

North American Society of Acupuncture and Alternative Medi- 
cine. (December 28, 2000). 

Douglas Dupler 
Teresa G. Odle 

Acute homeopathic remedies see 

Homeopathy, acute prescribing 

ADD see Attention-deficit hyperactivity 

Addiction see Alcoholism; Substance abuse 
and dependence 



Ademetionine, also known as SAMe, is a specific 
form of the amino acid methionine known as S-adeno- 
syl-methionine. The body manufactures it, and it is found 
in most tissues of the body. Ademetionine is essential for 
the formation of glutathione, a water-soluble peptide that 
helps the body fight free radicals. SAMe also helps the 
liver to process fats (protecting against a fatty liver) and is 
believed to play a role in protecting the body from heart 
disease. SAMe is a methyl donor, which means that it 
provides other molecules with methyl groups that are 
critical to their metabolism. In general, ademetionine 
raises the level of functioning of other amino acids in the 
body. Severe deficiencies of SAMe can cause problems 
with other important body functions, such as secretion of 
important hormones like melatonin, which plays a key 
role in regulating sleep and circadian rhythms. 

General use 

The synthetic formula of ademetionine has been 
hailed as an anti-aging formula because it is such a power- 
ful antioxidant. Antioxidants are substances that counter- 
act the damaging effects of free radicals in human tissue. 
Ademetionine has been widely popularized recently, but it 
is not a recent discovery. In fact it was discovered in Italy 
in 1952, and has been widely researched over the past few 
decades. In the 1970s, Italian researchers investigating its 


properties as a treatment for schizophrenia discovered 
that it also had definite antidepressant properties. Ademe- 
tionine became a useful treatment only during the 1990s, 
however, when scientists found a way to stabilize it for re- 
search purposes. After that technological development, 
ademetionine could be sold as a medical supplement. 

Ademetionine has been used successfully to treat de- 
pression, arthritis, schizophrenia, liver disease, periph- 
eral neuropathy, and other illnesses. Many people who 
have these illnesses, particularly schizophrenia, peripher- 
al neuropathy, and myelopathy, may have low blood lev- 
els of folic acid, vitamin B 12 , and certain amino acids, 
particularly SAMe and those with which it interacts. 

Pain relief 

The effectiveness of ademetionine has been studied 
in clinical trials with human subjects. One six-week study 
compared SAMe to transcutaneous electrical nerve stim- 
ulation (TENS), which is a popular form of pain relief in 
Europe. SAMe proved to be a more effective treatment. 

Liver function 

SAMe has been found to restore normal liver func- 
tion in patients suffering from a variety of liver disease, 
both alcohol induced and other. It has also been found to 
reverse liver damage resulting from the ingestion of vari- 
ous drugs and chemical agents (paracetamol and others). 


Several clinical trials found that ademetionine has a 
rapid effect on depression. Within double blind trials, 
ademetionine was found to have a markedly greater ef- 
fect than placebos, with only mild side effects. Although 
the substance seems to work surprisingly well on most 
forms of depression, a study done at Northwick Park 
Hospital in Harrow, England, suggests that it is more ef- 
fective for endogenous depression (depression that does 
not have an obvious external cause) than for neurotic de- 
pression (depression that has an identifiable cause). 

These findings may be related to the fact that pa- 
tients suffering from endogenous forms of depression are 
often found to have low levels of this amino acid. This is 
a particularly exciting discovery, because endogenous 
depression is the most difficult form to treat. Ademetion- 
ine was found to be particularly helpful to post- 
menopausal women suffering from depression. Some 
practitioners are suggesting the use of ademetionine in 
conjunction with other antidepressants to shorten the pe- 
riod between the beginning of antidepressant treatment 
and the patient’s sense of improvement. Since ademetio- 
nine generally has fewer side effects than many antide- 
pressants, it may be preferable to use it alone. 


Peripheral neuropathy 

Ademetionine has been used successfully to treat 
cases of peripheral neuropathy that had not previously 
responded to treatment with vitamin B 12 (cyanocobal- 
amin). This is an important discovery, because peripheral 
neuropathy is difficult to treat. 


Ademetionine has been found to be a useful 
painkiller. Over the long term, it may work less rapidly 
than some other analgesics, but it does not have the high 
incidence of gastrointestinal disturbance that results 
from taking ibuprofen, for example. Ademetionine may 
be the answer for patients who also suffer from GI tract 
diseases and cannot safely take other analgesics. 


Fibromyalgia is characterized by persistent muscle 
pain and aching that has no apparent cause. One Scandi- 
navian study noted that patients with fibromyalgia who 
took SAMe showed some improvement. 


Studies have shown that osteoarthritis patients not 
only experienced less pain while taking ademetionine, 
but that the depression that often accompanies the dis- 
ease was less evident. Ademetionine is also less toxic 
than the allopathic drugs used to treat such diseases. 

Alzheimer’s and Parkinson’s diseases 

Ademetionine has been shown to treat nerve dam- 
age and depression sometimes as effectively as standard 
pharmaceutical drugs without serious side effects. Some 
believe that SAMe may increase the effectiveness of lev- 
odopa, which is the drug most often prescribed for 
Parkinson’s disease. 


Ademetionine is available in preparations for oral, 
intravenous, and intramuscular administration. Treat- 
ment with ademetionine should always be monitored by 
a qualified practitioner. 

For liver function: 200 mg of ademetionine can be 
taken twice daily, gradually raising the dosage to 400 mg 
three times daily. Patients with peripheral neuropathy 
have been given dosages as high as 1600 mg daily. 

For depression the following program may be effec- 
tive: 200 mg taken twice daily for the first two days. For the 
third to the ninth day, dosage may be increased to 400 mg 
twice daily, and for days ten to nineteen, 400 mg should be 



Adie's pupil 

taken three times daily. After the twentieth day, the dosage 
should be stabilized at 400 mg four times daily. Some prac- 
titioners recommend doses as high as 1600 mg daily. 

Migraine and fibromyalgia sufferers can take 200 
mg of ademetionine twice daily, increasing to 600 mg 
doses. Osteoarthritis patients may be advised to take as 
much as 1200 mg daily for effective treatment. 


Patients with serious diseases such as those men- 
tioned above should seek the help of a qualified practition- 
er. It is significant, however, that no patient has ever 
dropped out of studies related to ademetionine testing due 
to side effects, even though it has been administered in 
high doses and in all forms, i.e., orally, intravenously, and 
intramuscularly. In addition, antidepressants, particularly 
the tricyclics, may cause accidental or intentional overdos- 
es. SAMe is also free of the hazard of potential addiction. 

One possible drawback to ademetionine treatment is 
its cost. A month’s supply may cost between $60 and 
$100. This is about the same as the cost of many antide- 
pressants, but ademetionine is less likely to be covered 
by medical insurance. 

Side effects 

SAMe is not suitable for patients with bipolar disor- 
der, as it may amplify the manic phase of the condition. 

The only side effects observed with SAMe in clini- 
cal trials were mild gastrointestinal distress. 

In patients who are deficient in the B vitamins, no- 
tably B 6 and B 12 , there is a danger that SAMe may break 
down to form homocysteine, an amino acid that has been 
linked to heart disease and stroke. If the patient’s levels 
of B vitamins are maintained, however, the body will be 
able to convert the homocysteine back into methionine 
and glutathione, and the use of SAMe will not increase 
the risk of heart disease. 


Ademetionine should not be used in conjunction 
with prescription medications for depression, as it in- 
creases their effects. It should also not be taken with 
MAO inhibitors, as it may produce a toxic reaction. Last- 
ly, it should not be given to pregnant or lactating women. 



Fournier, Isabelle, et al. “Folate Deficiency Alters Melatonin 

Secretion in Rats.’’ The Journal of Nutrition (September 

2002): 2781. 



Analgesic — Any remedy that relieves pain. 
Fibromyalgia — Chronic muscular or nerve pain 
that has no obvious cause. 

Free radicals — Unstable molecules resulting from 
oxidation that cause damage to human tissue, in- 
cluding signs of aging. 

Glutathione — A water-soluble peptide composed 
of cysteine, glycine, and glutamic acid. It func- 
tions as an antioxidant. The body uses ademetion- 
ine to form glutathione. 

Myelopathy — Any disease of the spinal cord or 
bone marrow. 

Peripheral neuropathy — Damage to the nerve 
endings of the hands and feet, often as a result of 

Transcutaneous electrical nerve stimulation 
(TENS)— A treatment for chronic pain that in- 
volves the use of a self-operated portable device. 
The device sends electrical impulses through elec- 
trodes placed over the painful area. 


American Holistic Medicine Association. http://www.holistic 

The Linus Pauling Institute, 

Patricia Skinner 
Teresa G. Odle 

ADHD see Attention-deficit hyperactivity 

Adie's pupil 


Adie’s pupil is a neurological condition of unknown 
origin with an unusual, asymmetric presentation known 
as anisocoria, an inequality in the size of the pupils of 
the eyes. It is believed to be a result of damage to the 
nerve innervating a muscle of the eye known as the cil- 
iary body. Alternately, the problem may be located at the 
ciliary ganglion, a kind of nerve junction structure from 


which the nerve to the ciliary body runs. Accommoda- 
tion, or the adjustment of the eye for distance, is affect- 
ed, as well as pupillary dilation and contraction, the abil- 
ity of the eye’s iris to open or close in response to ambi- 
ent light. Adie’s pupil primarily affects women from 20 
to 40 years of age. It is considered to be a benign condi- 
tion with no known cure. When Deep Tendon Reflexes 
(DTRs) of the legs — knee and ankle jerks — are also af- 
fected, accompanied by symptoms including localized, 
discreet areas of the skin that do not sweat, postural hy- 
potension (low blood pressure related to sudden standing 
or rising), and unsteady heart rhythms, the condition is 
referred to as Adie’s syndrome. 


The eyes are a complex anatomical and neurological 
unit. The outer surface of each eye is protected by a 
cornea — a normally clear cover that initiates the bending 
of light rays into the eye. Beneath the cornea lies the col- 
orful iris, a membrane containing two muscles capable of 
contracting and dilating like the diaphragm of a camera 
as it floats in the “aqueous humor.” Beneath the iris, the 
lens, under the influence of the ciliary body, further bends 
and directs the incoming light back to the retina, where it 
is received and transferred through the optic nerve at the 
back of the eye to the visual center of the brain (the visual 
cortex) at the back of the head. From the visual cortex, in- 
struction based on whether the object of vision is near or 
far, and whether the surrounding light is bright or dim, 
goes back to the muscles of the eye — the ciliary body — 
through the ciliary ganglion, and results in a re-shaping 
of the lens (accommodation) and an opening or closing of 
the pupil (pupillary reaction), as needed, in order to focus 
more sharply. Under normal circumstances, brightness 
and accommodation for near vision will result in contrac- 
ture of the ciliary body and the pupil, whereas darkness 
and accommodation for distance normally results in a re- 
laxation of the ciliary body and dilation of the pupil. For 
a person with Adie’s pupil, however, nerve signals arriv- 
ing at the ciliary body of one eye are weaker than to the 
other eye, believed to be a result of damage to or degener- 
ation of the ciliary ganglion or the ciliary body. The af- 
fected eye muscle is unable to contract, dilate, or focus 
with the same strength and speed as the unaffected eye. 
Relative to the opposite, unaffected eye, in normal day- 
light the pupil of the affected eye will be larger whereas, 
in a quickly darkened room, the affected eye will be 
smaller. Furthermore, the nerve from the ciliary ganglion 
to the ciliary body has 30 fibers dedicated to changing the 
shape of the lens and only one fiber dedicated to dilating 
the iris. As a result, a person with Adie’s pupil is even less 
able to dilate their pupil than to focus. Some research 
suggests that as the person ages, the ability to dilate grad- 


ually lessens to the point that the eye may have a smaller 
(constricted) pupil almost all the time. 

The list of other names by which Adie’s Pupil is 
known includes: Adie’s Tonic Pupil; Tonic Pupil Syn- 
drome; Holmes-Adie Syndrome and Adie-FIolmes Syn- 
drome; Psuedotabes, Papillotonic Psuedotabes, and 
Psuedotabes pupillotonica; Kehrer-Adie Syndrome; 
Markus’ Syndrome; Weill’s Syndrome, Weill-Reys Syn- 
drome, and Weill-Reys-Adie Syndrome; Psuedo- Argyll 
Robertson Pupil, Psuedo-Argyll Robertson Syndrome, 
and Nonluetic Argyll-Robertson Pupil; Myotonic Pupil 
and Myotonic Pupillary Reaction; Saenger’s Syndrome; 
and. Constitutional areflexy-tridoplegia interna. These 
many names derive from the lengthy history of study of 
this condition, beginning in 1813, when James Ware, a 
London ophthalmologist, or medical doctor specializing 
in the eyes, described some of these symptoms. Dr. Adie 
added to an already long list of doctors who had studied 
it, when in 1931 he described the condition as self-gen- 
erating. It was first referred to as Adie’s syndrome in 
1934 by the French neurologist, Jean-Alexandre Barre. 

Causes & symptoms 

Some external causes such as trauma or surgery to the 
eye, and some internal causes such as an unknown virus, 
an inflammatory condition, or a familial tendency have 
been suggested. In the case of trauma or surgery, it is be- 
lieved that the damaged or cut nerve fails to regrow with all 
fibers running in the same direction for proper reattach- 
ment to the ciliary body. The propensity to affect women 
between 20 and 40 years of age more than men of all ages 
promoted one doctor to speculate that it may be, or related 
to, an autoimmune disorder, especially when the individual 
lives a stressful lifestyle and other related family members 
have suffered neurological diseases or disorders. Caffeine, 
a high sugar diet, or an imbalance in essential fatty acids 
that are important in maintaining nerve health may also be 
factors, but no studies have been identified supporting this 
hypothesis. Occasionally similar symptoms are seen in 
syphilitic persons; however, one source notes that as early 
as 1914, syphilis was ruled out as the cause of this condi- 
tion. This unusual pupillary reflex, also known as “tonic 
pupil,” because it is slow to change, may also be associated 
with diabetes, alcoholism, a herpes viral infection, or a 
cranial arterial condition known as giant cell arteritis. 
Symptoms, in addition to the slow-to-respond, differently 
sized pupil of the affected eye, may include headache, as a 
result of the strain on the vision, a sensitivity to bright 
lights, and loss of some reflexes, especially the knee-jerk. 


Diagnosis is made on the basis of a thorough history 
and physical examination, followed by tests to rule out 


Adie's pupil 

Adie's pupil 

other suspected causes according to the persons history. 
An examination of the eye using a “slit lamp” — an in- 
tensely bright lamp shielded by a shade with a slit it it — 
reveals undulating, irregular, worm-like movements with 
a segmented or ratcheted appearance in the iris of the af- 
fected eye, uncoupled to movements in the iris of the un- 
affected eye. A positive (hypersensitive) reaction to pilo- 
carpine drops, an alkaloid substance from the jaborandi 
tree that causes the otherwise slow-to-constrict pupil to 
constrict intensely, is considered diagnostically additive. 


No specific treatments were noted; however, treat- 
ments that strengthen or protect the nervous system 
might be helpful, treatments such as the B complex of 
vitamins, antioxidants including Vitamins C and E, 
alpha lipoic acid, and Superoxidedismutase (S.O.D.), 
and dietary modifications of fat that have been found 
helpful in multiple sclerosis, another condition due to 
damage to nerve pathways affecting nerve transmission, 
including intake of essential fatty acids and reduced in- 
take of trans-fatty acids and hydrogenated fats. Dietary 
reductions in caffeine and sugar, including sugar substi- 
tutes like aspartame, may be helpful. Lifestyle practices 
that reduce stress and tone the parasympathetic nervous 
system, such as yoga or massage, may be helpful. 

Allopathic treatment 

No specific treatments were noted, however cosmet- 
ic use of dilute pilocarpine drops to constrict the tonic 
pupil was suggested. 


Partial recovery of function is more likely if the initi- 
ating damage was to the ciliary body rather than to the 
ciliary ganglion. As a result of the number of fibers dedi- 
cated to each from the ciliary ganglion, recovery of inner- 
vation to the lens controlling function is more likely than 
recovery of the pupillary reactive function. One source 
noted also that reinnervation may be slow, segmental and 
irregular, similar to the ocular symptoms themselves. 


No preventative measures were noted. 



Bates, Barbara. A Pocket Guide to Physical Examination and 

History Taking. Philadelphia: Lippincott, 1991. 

Mareib, Elaine N. Essentials of Human Anatomy and Physiolo- 
gy. 3rd ed. Benjamin/Cummings, 1991. pp. 219 



Accommodation — The adjustment made through 
a change in shape of the lens allowing for vision 
of objects near and far. 

Aqueous humor — A clear fluid in the posterior 
and anterior chambers of the eye that moves from 
back to front and exits the eye through a small 
canal into the venous system. 

Knee and ankle jerk reflexes — Normal reflexes 
elicited usually by testing with a reflex hammer 
and demonstrating, by being present, a healthy 
and intact nervous system. 

Pupillary reaction — The normal change in the size 
of the pupil due to the amount of ambient light. 
Under normal circumstances, both pupils respond 
simultaneously and equally. 

Tonic pupil — A pupil that is slow to change. 

Pavan-Langston, Deborah. Manual of Ocular Diagnosis & 
Therapy, 4th ed. Little, Brown & Co., 1995, pp. 336. 

Simon, Roger P., Michael J. Arnihoff, and David A. Greenberg. 
Clinical Neurology, 4th ed. Stamford: Appleton & Lange, 
1999, pp. 145. 

Tasman, M.D., William. Duane’ s Clinical Ophthalmology. 
2.15. Philadelphia: Lippincott, 1992. pp. 12. 

Vander, M.D., Arthur J., James H. Sherman, Ph.D., and 
Dorothy S. Luciano, Ph.D. Human Physiology, Mechanics 
of Body Function, 5th ed. McGraw Hill, 1990, pp. 310. 

Vaughn, Daniel, Taylor Asbury, and Paul Riordan-Eva. General 
Ophthalmology, 15th ed. Stamford: Appleton & Lange, 
1999, pp. 267. 


Enersen, Ole Daniel. Adie’s syndrome. 1994-2001. [cited May 
12, 2004], < 

Genetic Information and Patient Services, Inc. (GAPS) “The 
Gaps Index.” Adie Syndrome, [cited May 12, 2004]. 

World & Medicine — Ophthalmology. Encyclopaedia of Oph- 
thalmology — Greatest Links’ Collection. “Adie's syn- 
drome." In Principles of Neurology, 6th ed., p.279. [cited 
May 12, 2004]. < 
o_mot il/om_06 ,htm> . 

Katherine E. Nelson, N.D. 

African medicine see Traditional African 


African pygeum 


African pygeum (Primus africana), also known as 
pygeum africanum, pygeum, and African plum tree, is an 
evergreen tree native to higher elevations of southern 
Africa. A 150 ft (46 m) tall member of the Rose family 
(Rosacea), pygeum has been found to be useful in treat- 
ing prostate problems, particularly benign prostatic hy- 
pertrophy (BPH), a condition affecting many men. 

The tree’s bark contains an oil with many active in- 
gredients; waxes, fatty acids, and other less familiar 
compounds. Pygeum’s principal biological activity is 
traced to a “phytosterol” compound known as beta-sitos- 
terol. Phyto (plant) sterols are structurally similar to, but 
much less efficiently absorbed from the diet than, cho- 
lesterol. The biological strength of phytosterols, howev- 
er, is similar to that of hormones; therefore, a very small 
amount seems sufficient to initiate a response. Pygeum’s 
phytosterols are anti-inflammatory. Pygeum also reduces 
edema (the swelling caused by an excess of fluids), re- 
duces levels of the hormone prolactin, lowers and in- 
hibits cholesterol activity within the prostate. Prolactin, 
whose levels are increased by drinking beer, stimulates 
testosterone uptake by the prostate, reportedly increasing 
levels of a metabolite responsible for prostatic cell in- 
creases, dihydrotestosterone (di-hydro-testosterone), 
(DHT). Cholesterol is reported to increase the influence 
of DHT. BPH imlies two prostate changes: increased 
size and increase tissue density. These changes cause 
symptoms of frequent urge to urinate small volumes, re- 
duced prostatic secretions, reduced bladder emptying. 
Incomplete bladder emptying increases risk of bladder 
infections, edema and inflammation, and possibly, pro- 
static cancer. Blood sugar levels and immune function 
have also been found to improve. 

In summary, african pygeum’s medicinal actions in- 

• anti-inflamation 

• reducing edema of the prostate 

• inhibit cellular increase 

• improving the natural flow of prostatic secretions 

• lowering cholesterol 

• regulating insulin activity, thereby affecting blood 
sugar levels 

• regulating the immune system 

Although pygeum’s use is relatively new to the 
United States, it has been imported from Africa to Eu- 
rope since the 1700s, and is still used today as a major 


treatment for BPH. Europeans learned of this plant’s 
usefulness in treating what was then known as “old 
man’s disease”. It continues to be a widely popular in 
Europe as a remedy for BPH, especially in France where 
the use of African pygeum for BPH is reported to be 'ns 
about 80%. | 

General use 

Pygeum is Primarily used to treat benign prostatic 
hypertrophy or BPH, a condition which affects men as 
early as their 40s, but increasingly with age: 30% of fifty 
year olds; 50% of sixty year olds; and nearly 80% of 
men 70 and older. It has been found to be of use in the 
related condition of chronic prostatitis, with and without 
prostate related sexual dysfunction, and infertility due 
to reduced prostatic secretions. Due to actions as an im- 
mune system “up regulator” and anti-inflammatory, 
pygeum is also being studied for use with other treat- 
ments for hepatitis C and HIV. 

According to one source, in a double blind placebo 
controlled study involving 263 men on a dose of 1 00 mg 
per day of African pygeum extract for 60 days, the fol- 
lowing improvements versus controls were observed: 

•31% decrease in “nocturia,” or night-time frequency 

• 24.5% decrease in “residual urine,” the amount of urine 
left in the bladder after urination 

• 50% increase in overall relief and feeling of wellbeing. 

Two-thirds of the group using Pygeum reported 
feeling satisfaction. This was twice the improvement re- 
ported by the control group on placebo. 

In a study on chronic prostatitis, 60% of men with 
urinary tract infections and nearly 80% of men without 
infections reported improvements using 100 mg of 
Pygeum extract for five to seven weeks. In the treatment 
of sexual dysfunction due to chronic prostatitis, a dose of 
200 mg for 60 days, with or without an antibiotic, pro- 
duced improvements in urination and sexual function. 
The few small and relatively short clinical trials of 
pygeum in the treatment of Hepatitis C and HIV+ infec- 
tions have been statistically significant; further trials are 
under way in South Africa. 


Since the 1960s, in Europe, the most commonly used 
form is the standardized herbal extract. The process is 
highly technical and, for Pygeum, is designed to target 
extraction of the active oils using a sequence of laborato- 
ry extraction procedures. Standardization is the process 
whereby the targeted active ingredients are quantified and 


• 17.2% increase in urine flow 


African pygeum 

concentrated to a consistent therapeutic dose. The widely 
modern use of the extract form of African pygeum in- 
stead of the whole plant may derive from the discovery 
that the plant’s activity is primarily due to its alcohol sol- 
uble phytosterols. A month’s supply in capsules at a daily 
dosage of 100 mg, standardized to contain approximately 
14% of the active beta-sitosterol ingredient, costs be- 
tween $40 and $50. In some preparations, synergistic in- 
gredients such as amino acids, other herbs, and vitamins 
or minerals, may be included. Studies cited used dosages 
of 100 mg daily; however, one study compared and found 
two dosages of 50 mg versus one dose of 100 mg per day 
had the same therapeutic effect. 


Precautions noted include recommendations to seek 
the guidance of a healthcare professional, and not to self 
treat. Pygeum may cause a hormonal shift, and is not rec- 
ommended for children. Also noted: pygeum may require 
several weeks to months to make a noticeable difference; 
studies noted reported benefits at ranges of five to eight 
weeks. One source reported pygeum relieves symptoms 
but does not reduce prostatic size. Another study specifi- 
cally stated that the active components of pygeum have 
symptom reversal and prevention characteristics. 

Side effects 

Pygeum appears to be relatively safe and non-toxic. 
One report noted rare occurrences of diarrhea, dizziness, 
disturbed vision, gastric pain and constipation. One 
study reported satisfactory safety profiles after 12 months 
of using 100 mg daily in 174 subjects. In animal studies it 
was reported that dogs and rats given amounts equivalent 
to more than 500 times the therapeutic dose showed no 
adverse effects, and amounts equivalent to 50 times the 
therapeutic dose had no effect on fertility. In vivo and in 
vitro studies showed no carcinogenic effects. In fact, 
pygeum ’s constituents have been found to be anti-carcino- 
genic. The National Institute of Health (NIH), in 2002, es- 
tablished a grant for a randomized controlled clinical 
study involving 3,100 men, in order to learn more about 
the medical potential of this alternative therapy, due to in- 
creased BPH diagnoses as the population ages. 


Synergistic supplements may facilitate benefits. One 
report advised dietary adjustments to enhance beneficial 
result. Dietary recommendations to improve prostatic 
health included avoiding the irritants of coffee and to- 
bacco; eating pumpkin seeds for their zinc and Omega 3 
anti-inflammatory content; increasing other dietary 



Benign prostatic hypertrophy (BPH) — A condition 
in many men affecting the prostate, wherein in- 
creased number and size of cells produces many 
urinary related symptoms. 

Beta-sitosterol — A plant lipid with considerable 
biological activity; even in very amounts it is 
found to be anti-inflammatory and to have posi- 
tive effects in treating BPH. 

Dihydrotestosterone (DHT) — A testosterone 
metabolite implicated in the increase in size and 
number of prostatic cells. 

Double blind placebo controlled study — A study 
in which neither the patient nor the drug adminis- 
trator knows who is receiving the trial drug and 
who the placebo. 

Metabolite — A by product of the physical and 
chemical change process known as metabolism. 
Prolactin — A hormone found in lactating women, 
and in men. Levels are increased by drinking beer. 

Prostatic secretions — Normal secretions of the 
prostate gland intended to nourish and protect 
sperm, improving fertility. 

Standardized herbal extract — An herbal product 
created by using water or alcohol to dissolve and 
concentrate the active ingredients, which are then 
quantified for medicinal pharmacological effect. 
Synergistic — Describes an association which im- 
proves the effectiveness of members of the associ- 

Testosterone — The primary male reproductive 
hormone. Uptake into prostatic tissues is stimulat- 
ed by prolactin; its DHT metabolite stimulates 
prostatic cell increases. 

sources of Omega 3s, including the cold water fishes 
salmon, sardines, and mackerel; taking antioxidants and 
a good multiple vitamin; and the synergistic herb saw 
palmetto ( Serenoa repens ), said to be more effective 
than the pharmaceutical for BPH, Proscar, at inhibiting 
the conversion of testosterone to its metabolite DHT, im- 
plicated in prostatic cell increases. Vitamins E (400 IU) 
and B 6 (50-100mg) were suggested to synergistically re- 
duce prolactin levels. It was also noted that 200 meg of 
selenium daily reduce the risk of prostate cancer. 

No unfavorable interactions were noted. Common 
sense might suggest that any lifestyle habit that aggra- 
vates prostate health, for example, a high cholesterol, 


high fat, high red meat, low fiber diet, frequent and high 
intake of beer, and lack of exercise may decrease the ef- 
fectiveness of pygeum or other medications indicated for 
prostate health. Because pygeum has been found to up- 
regulate immunity, its use may be contra-indicated 
where immune system upregulation is undesirable. No 
unfavorable herb-drug interactions have been noted. 



Chevallier, Andrew. The Encyclopedia of Medicinal Plants. 
D.K. Publishing. 1996. 


Miller, N.D., Alan L. “Benign Prostatic Hyperplasia, Nutrition- 
al and Botanical Therapeutic Options." Alternative Medi- 
cine Review 1.1. (2001). 

Patrick, N.D., Lyn. “Hepatits C: Epidemiology and Review of 
Complementary/ Alternative Medicine Treatments.” Alter- 
native Medicine Review. (2001). 


Brown, Don. "The Male Dilemma: Relief For Prostate Prob- 
lems.” Total Health 12 June 1990. [cited May 7, 2004]. 
<> Record# 

Iyker, Robert. “Men’s Health: Straight Talk On Your Health 
and Life.” Natural Health April 1999. <http://www.find>. 

"The National Institutes of Health is Proceeding on a Study to 
Determine if the Dietary Supplement Ingredients. . .Saw 
Palmetto and Pygeum.” Food Chemical News 43.52. Feb- 
ruary 11, 2002. [cited May 7, 2004]. <http://galenet.>. 

"Pygeum africanum ( Primus Africana) (African plum tree).” Al- 
ternative Medicine Review 7.1. February 2002. [cited May 
7, 2004], <>. 

Katy Nelson, N.D. 



Agastache is a genus of plants found almost world- 
wide. Different species are used in several native cul- 
tures for healing. The best know of these is Agastache 
rugosa, also called the giant hyssop, wrinkled giant hys- 
sop, Korean mint, or in Chinese Huo xiang. 

Agastache rugosa is a perennial or biennial plant that 
grows to a height of 4 ft (1.2 m). It is native to China, but 
has spread to Japan, Korea, Laos, and Russia. It grows 
wild on sunny hillsides and along roads, but also can be 


cultivated in backyard gardens. The highly aromatic 
leaves and purple or red flowers are used for healing. 

Several other species of agastache found in other 
parts of the world are used in healing. These include A. 
nepetoides (yellow giant hyssop ), A. foeniculum (anise 
hyssop), and A. mexicana. Leaf and flower color vary 
considerably among the different species. Many species 
of agastache also are grown commercially in the United 
States for landscaping. In southern China and Taiwan, 
Pogostemon cahlin , a relative of Pogostemon patchouli , 
the Indian plant that produces patchouli oil, is used inter- 
changeably with A. rugosa. 

General use 

A. rugosa is used extensively in Chinese herbalism. 
It’s first recorded use dates from about 500 a.d. It is asso- 
ciated with the lungs, spleen, and stomach and is classi- 
fied as having a warm nature and an acrid and aromatic 
taste. Traditionally, agastache has been associated the 
treatment of several different sets of symptoms. It has 
long been used to treat stomach flu, stomachache, nau- 
sea, vomiting, diarrhea, abdominal bloating, and ab- 
dominal pain. It is combined with Scutellaria (skullcap) 
to treat morning sickness in pregnant women. It is also a 
component of formulas that improve digestive balance by 
aiding the absorption of nutrients and intestinal function. 

In Chinese herbalism, A. rugosa is also used to treat 
summer flu or summer colds with accompanying low 
fever, feelings of fullness in the chest, and headache. It 
is also used to treat dark urine and a feeling of heaviness 
in the arms and legs. A lotion containing A. rugosa is ap- 
plied externally to treat fungal infections. 

Other cultures independently have discovered simi- 
lar uses for other species of agastache. A. mexicana is 
grown in Mexico and used to treat gastrointestinal up- 
sets, nervous, and cardiovascular ailments. The leaves of 
A. nepetoides are used by Native Americans to treat skin 
rashes caused by poison ivy. A. foeniculum leaves have a 
strong licorice taste (accounting for its English name, 
anise hyssop). These leaves can be brewed in a tea to 
treat coughs, fever, and colds. 

Although rigorous scientific testing of the healing 
claims made for agastache is scarce, one 1999 study 
done at Seoul National University in Korea has shown 
that in test tube experiments an extract of the root of A. 
rugosa significantly inhibited the action of certain pro- 
teins associated with the reproduction of the HIV virus. 


Agastache can be prepared alone as a tea, incorpo- 
rated into a lotion, or prepared as a pill. The leaves are 





Biennial — Biennial plants take two years to com- 
plete their life cycle and produce fruit and flowers 
only in the second year. 

Qi — Qi is the Chinese term for the vital life force 
that permeates the body. According to traditional 
Chinese medicine, qi collects in channels in the 
body and can be moved and redirected through 
treatments and therapies. 

strongly aromatic, but lose this quality with prolonged 
boiling (over 15 minutes). Therefore agastache is added 
last in formulas that must be boiled. 

The best know formulas using agastache are agas- 
tache formula and Huo Xiang Zheng Qi Wan, or agas- 
tache qi-correcting formula. Agastache formula is used 
to harmonize the stomach. It is given as treatment for 
gastrointestinal upsets with chills, fever, and diarrhea. 

Huo Xiang Zheng Qi Wan regulates qi and treats 
seasonal gastric disorders, especially those occurring 
during hot, humid weather. This formula is commercial- 
ly available in both tablet and liquid form. Other cultures 
prepare agastache either as a tea to be drunk, or use the 
leaves externally. 


Agastache has a long history of use with no substan- 
tial reported problems. 

Side effects 

No side effects have been reported with the use of 


Agastache is often used in conjunction with other 
herbs with no reported interactions. Since agastache has 
been used almost exclusively in Chinese medicine, there 
are no studies of its interactions with Western pharma- 



Chevallier, Andrew. Encyclopedia of Medicinal Plants. Boston: 
DK Publishers, 1996. 

Molony, David. Complete Guide to Chinese Herbal Medicine. 
New York: Berkeley Books, 1998. 


Zhu, Chun-Han. Clinical Handbook of Chinese Prepared Med- 
icines. Brookline, MA: Paradigm Publications, 1989. 


American Association of Oriental Medicine (AAOM). 433 
Front Street, Catasauqua, PA 18032. (610) 266-2433 

Tish Davidson 



Starting at what is commonly called middle age, op- 
erations of the human body become more vulnerable to 
daily wear and tear. There is a general decline in physical, 
and possibly mental, functioning. In the Western coun- 
tries, the length of life often extends into the 70s. Howev- 
er, the upward limit of the life span can be as high as 120 
years. During the latter half of life, an individual is more 
prone to problems with the various functions of the body, 
and to a number of chronic or fatal diseases. The cardio- 
vascular, digestive, excretory, nervous, reproductive, and 
urinary systems are particularly affected. The most com- 
mon diseases of aging include Alzheimer’s, arthritis, can- 
cer, diabetes, depression, and heart disease. 


Human beings reach a peak of growth and develop- 
ment during their mid 20s. Aging is the normal transition 
time after that flurry of activity. Although there are quite 
a few age-related changes that tax the body, disability is 
not necessarily a part of aging. Health and lifestyle fac- 
tors, together with the genetic makeup of the individual, 
determine the response to these changes. Body functions 
that are most often affected by age include: 

• Hearing, which declines especially in relation to the 
highest pitched tones. 

• The proportion of fat to muscle, which may increase by 
as much as 30%. Typically, the total padding of body 
fat directly under the skin thins out and accumulates 
around the stomach. The ability to excrete fats is im- 
paired, and therefore the storage of fats increases, in- 
cluding cholesterol and fat-soluble nutrients. 

• The amount of water in the body, which decreases, re- 
ducing the body’s ability to absorb water-soluble nutri- 
ents. Also, there is less saliva and other lubricating fluids. 

• Liver and kidney activities, which become less effi- 
cient, thus affecting the elimination of wastes. 


Average annual growth rate (in percent) of the elderly population: 1910-30 to 2030-50. (Graph by Dana Hansen.) 

• The ease of digestion, which is decreased, resulting in a 
reduction in stomach acid production. 

• Muscle strength and coordination, which lessens, with 
an accompanying loss of mobility, agility, and flexibility. 

• Sexual hormones and sexual function, which both de- 

• Sensations of taste and smell, which decrease. 

• Cardiovascular and respiratory systems, with changes 
leading to decreased oxygen and nutrients throughout 
the body. 

• Nervous system, which experiences changes that result 
in less efficient nerve impulse transmission, reflexes that 
are not as sharp, and diminished memory and learning. 

• Bone strength and density, which decrease. 

• Hormone levels, which gradually decline. The thyroid 
and sexual hormones are particularly affected. 

• Visual abilities, which decline. Age-related changes 
may lead to diseases such as macular degeneration. 

• A compromised ability to produce vitamin D from 


• Protein formation, which is reduced, leading to shrink- 
age in muscle mass and decreased bone formation, pos- 
sibly contributing to osteoporosis. 

Causes & symptoms 

There are several theories on why the aging body 
loses functioning. It may be that several factors work to- 
gether or that one particular factor is the culprit in a 
given individual. These theories include: 

• Programmed senescence, or aging clock, theory. The 
aging of the cells for each individual is programmed 
into the genes, and there is a preset number of possible 
rejuvenations in the life of a given cell. When cells die 
at a rate faster than they are replaced, organs do not 
function properly, and they become unable to maintain 
the functions necessary for life. 

• Genetic theory. Human cells maintain their own seed of 
destruction at the chromosome level. 

• Connective tissue, or cross-linking theory. Changes in 
the makeup of the connective tissue alter the stability of 
body structures, causing a loss of elasticity and func- 
tioning, and leading to symptoms of aging. 




• Free -radical theory. The most commonly held theory of 
aging, is based on the fact that ongoing chemical reac- 
tions of the cells produce free radicals. In the presence 
of oxygen, these free radicals cause the cells of the 
body to break down. As time goes on, more cells die or 
lose the ability to function, and the body ceases to 
function as a whole. 

• Immunological theory. There are changes in the im- 
mune system as it begins to wear out, and the body is 
more prone to infections and tissue damage, which 
may ultimately cause death. Also, as the system breaks 
down, the body is more apt to have autoimmune reac- 
tions, in which the body’s own cells are mistaken for 
foreign material and are destroyed or damaged by the 
immune system. 


Many problems can arise due to age-related changes 
in the body. Although there is no individual test to mea- 
sure these changes, a thorough physical exam and a 
basic blood screening and blood chemistry panel can 
point to areas in need of further attention. When older 
people become ill, the first signs of disease are often 
nonspecific. Further exams should be conducted if any 
of the following occur: 

• diminished, or lack of, desire for food 

• increased confusion 

• failure to thrive 

• urinary incontinence 

• dizziness 

• weight loss 

• falling 


Nutritional supplements 

Consumption of a high-quality multivitamin is rec- 
ommended. Common nutritional deficiencies connected 
with aging include B vitamins, vitamin A and vitamin 
C, folic acid, calcium, magnesium, zinc, iron, chromi- 
um, and trace minerals. Since stomach acids may be de- 
creased, powdered multivitamin formula in gelatin cap- 
sules are suggested, as this form is the easiest to digest. 
Such formulas may also contain enzymes for further 
help with digestion. 

Antioxidants can help neutralize damage caused by 
free radical actions, which are thought to contribute to 
problems of aging. They are also helpful in preventing 
and treating cancer, and in treating cataracts and glau- 
coma. Supplements that serve as antioxidants include: 


•Vitamin E, 400-1,000 IUs daily. Protects cell mem- 
branes against damage. It shows promise in preventing 
heart disease, and Alzheimer’s and Parkinson’s diseases. 

• Selenium, 50 mg taken twice daily. Research suggests 
that selenium may play a role in reducing cancer risk. 

• Beta-carotene, 25,000-40,000 IUs daily. May help in 
treating cancer, colds and flu, arthritis, and immune 

• Vitamin C, 1,000-2,000 mg per day. It may cause diar- 
rhea in large doses. The dosage should be decreased if 
this occurs. 

Other supplements that are helpful in treating age- 
related problems include: 

• B l2 /B-complex vitamins. Studies show that B 12 may 
help reduce mental symptoms, such as confusion, 
memory loss, and depression. 

• Coenzyme Q 10 may be helpful in treating heart disease. 
Up to 75% of cardiac patients have been found to lack 
this heart enzyme. 


The following hormone supplements may be taken 
to prevent or treat various age-related problems. Howev- 
er, caution should be taken before beginning treatment, 
and the patient should consult his or her health care pro- 
fessional prior to hormone use. 

DHEA improves brain functioning and serves as a 
building block for many other important hormones. It 
may be helpful in restoring hormone levels that have de- 
clined, building muscle mass, strengthening bones, and 
maintaining a healthy heart. 

Melatonin may be helpful for insomnia. It has also 
been used to help fight viruses and bacterial infections, 
reduce the risk of heart disease, improve sexual function, 
and to protect against cancer. 

Human growth hormone (hGH) has been shown to 
regulate blood sugar levels and to stimulate bone, carti- 
lage, and muscle growth while reducing fat. 


Garlic ( Allium sativa ) is helpful in preventing heart 
disease, and improving the tone and texture of skin. Gar- 
lic stimulates liver and digestive system functions, and 
also helps manage heart disease and high blood pressure. 

Siberian ginseng ( Eleutherococcus senticosus) sup- 
ports the adrenal glands and immune functions. It is be- 
lieved to be helpful in treating problems related to stress. 
Siberian ginseng also increases mental and physical per- 


formance, and may be useful in treating memory loss, 
chronic fatigue, and immune dysfunction. 

Ginkgo biloba works particularly well on the brain 
and nervous system, it is effective in reducing the symp- 
toms of such conditions as Alzheimer’s disease, depres- 
sion, visual disorders, and problems of blood circulation. 
It may also help treat heart disease, strokes, dementia, 
Raynaud’s disease, head injuries, leg cramps, macular 
degeneration, tinnitus, impotence due to poor blood 
flow, and diabetes-related nerve damage. 

Proanthocyanidins, or PCO, (brand name Pycnogenol), 
are derived from grape seeds and skin, as well as pine tree 
bark. They may help prevent cancer and poor vision. 

Green tea has powerful antioxidant qualities, and 
has been used for centuries as a natural medicine in 
China, Japan, and other Asian cultures. In alternative 
medicine, it aids in treating cancer, rheumatoid arthri- 
tis, high cholesterol, heart disease, infection, and im- 
paired immune function. Several scientific studies have 
shown that antioxidant benefits are obtained by drinking 
two cups of green tea each day. 

In Ayurvedic medicine, aging is described as a 
process of increased vata, in which there is a tendency to 
become thinner, drier, more nervous, more restless, and 
more fearful, while experiencing declines in both sleep 
and appetite. Bananas, almonds, avocados, and coconuts 
are some of the foods used in correcting such conditions. 
One of the main herbs used to treat these problems is 
gotu kola ( Centella asiatica). It is taken to revitalize the 
nervous system and brain cells, and to fortify the im- 
mune system. Gotu kola is also used to treat memory 
loss, anxiety, and insomnia. 

In Chinese medicine, most symptoms of aging are 
regarded as signs of a yin deficiency. Moistening foods 
are recommended, and include barley soup, tofu, mung 
beans, wheat germ, spirulina, potatoes, black sesame 
seeds, walnuts, and flax seeds. Jing tonics may also be 
used. These include deer antler, dodder seeds, processed 
rehmannia, longevity soup, mussels, and chicken. 

Allopathic treatment 

For the most part, doctors prescribe medications to 
control the symptoms and diseases of aging. In the Unit- 
ed States, about two-thirds of people age 65 and over 
take medications for various conditions. More women 
than men use these medications. The most common 
drugs used by the elderly are painkillers, diuretics or 
water pills, sedatives, cardiac medications, antibiotics, 
and mental health remedies. 

Estrogen replacement therapy (ERT) is commonly 
prescribed to alleviate the symptoms of aging in post- 


menopausal women. It is often used in conjunction with 
progesterone. These drugs help keep bones strong, re- 
duce the risk of heart disease, restore vaginal lubrication, 
and improve skin elasticity. Evidence suggests that they 
may also help maintain mental functions. 

Expected results 

Aging is unavoidable, but major physical impair- 
ment is not. People can lead healthy, disability-free lives 
throughout their later years. A well-established support 
system of family, friends, and health care providers, 
along with a focus on good nutrition and lifestyle 
habits, and effective stress management, can prevent dis- 
ease and lessen the impact of chronic conditions. 


Preventive health practices such as healthy diet, 
daily exercise, stress management, and control of 
lifestyle habits, such as smoking and drinking, can 
lengthen the life span and improve the quality of life as 
people age. Exercise can improve appetite, bone 
health, emotional and mental outlook, digestion, and 

Drinking plenty of fluids aids in maintaining healthy 
skin, good digestion, and proper elimination of wastes. 
Up to eight glasses of water should be consumed daily, 
along with plenty of herbal teas, diluted fruit and veg- 
etable juices, and fresh fruits and vegetables that have a 
high water content. 

Because of a decrease in the sense of taste, older 
people often increase their salt intake, which can con- 
tribute to high blood pressure and nutrient loss. Use of 
sugar is also increased. Seaweeds and small amounts of 
honey can be used as replacements. 

Alcohol, nicotine, and caffeine all have potential 
damaging effects, and consumption should be limited or 
completely eliminated. 

A diet high in fiber and low in fat is recommended. 
Processed foods should be replaced by such complex 
carbohydrates as whole grains. If chewing becomes a 
problem, there should be an increased intake of protein 
drinks, freshly juiced fruits and vegetables, and 
creamed cereals. 



Cox, Harold. Aging. New York, NY: McGraw Hill College Di- 
vision, 2004. 

Giampapa, Vincent, et al. The Anti-Aging Solution: 5 Simple 

Steps to Looking and Feeling Young. Hoboken, NJ: John 

Wiley & Sons, 2004. 





Antioxidants — Substances that counteract the 
damaging effects of oxidation in the body's tis- 

Alzheimer's disease — A condition causing a de- 
cline in brain function that interferes with the abil- 
ity to reason and to perform daily activities. 

Senescence — Aging. 

Vata — One of the three main constitutional types 
found under Ayurvedic principles. Keeping one's 
particular constitution in balance is considered 
important in maintaining health. 

Panno, Joseph. Aging: Theories and Potential Therapies New 
York, NY: Facts on File. Inc., 2004. 

Landis, Robyn, with Karta Purkh Singh Khalsa. Herbal De- 
fense: Positioning Yourself to Triumph Over Illness and 
Aging New York, NY: Warner Books, 1997. 

Weil, Andrew M.D. Healthy Aging New York, NY: Knopf, 


“Chemopreventive Effects of Green Tea Said to Delay Aging of 
Skin.” Cancer Weekly (April 13, 2004): 10. 

“Discovery Claims to Link DNA Test to Reversing Signs of 
Aging.” Drug Week (February 27, 2004): 122. 

“Fitness Can Improve Thinking Among Aging.” Obesity, Fit- 
ness & Wellness Week (March 13, 2004): 16. 

“Hormonal Activity Plays Role in Body Composition Changes 
with Aging.” Obesity, Fitness & Wellness Week (March 20, 
2004): 3. 

Lofshult, Diane. “Aging Trends for 2004.” IDEA Health & Fit- 
ness Source (March 2004): 14. 

“Research Reports on Key Antioxidant to Slow Aging.” Drug 
Week (April 2, 2004): 194. 


The Anti- Aging Institute. 843 William Hilton Parkway. Hilton 
Head, SC 29928. (912) 238-3383. <http://www.anti-aging. 

The Rosenthal Center for Complementary and Alternative 
Medicine Research in Aging and Women's Health. Co- 
lumbia University, College of Physicians and Surgeons, 
630 W. 168th St., New York, NY 10032. <http://www.>. 


National Institute on Aging Senior Health Web site. <http://>. 

Patience Paradox 
Ken Wells 




Acquired immune deficiency syndrome (AIDS) is 
an infectious disease caused by the human immunodefi- 
ciency virus (HIV). It was first recognized in the United 
States in 1981. AIDS is the advanced form of infection 
with the HIV virus, which may not cause disease for a 
long period after the initial exposure (latency). Infection 
with HIV weakens the immune system which makes in- 
fected people susceptible to infection and cancer. 


AIDS is considered one of the most devastating pub- 
lic health problems in recent history. In 1996, the Centers 
for Disease Control and Prevention (CDC) estimated that 
one million persons in the United States were HlV-posi- 
tive, and 223,000 are living with AIDS. Of these patients, 
44% were gay or bisexual men, 26% are heterosexual in- 
travenous drug users, and 18% were women. In addition, 
approximately 1 ,000-2,000 children are born each year 
with HIV infection. In 2002, the CDC reported 42,136 
new AIDS diagnoses in the United States, a 2.2% increase 
from the previous year. AIDS cases rose among gay and 
bisexual men (7.1% in 25 states that report regularly). The 
disease also seems to be rising among older Americans. 
From 1990 to 2001, the number of cases in Americans age 
50 years or older rose from 16,288 to 90,153. 

The World Health Organization (WHO) estimates 
that 40 million people worldwide were infected with 
AIDS/HIV as of 2001. Most of these cases are in the de- 
veloping countries of Asia and Africa. In 2003, WHO 
cautioned that if treatment were not delivered soon to 
nearly 6 million people with AIDS in developing coun- 
tries, there could be 45 million cases by 2010. 

Risk factors 

AIDS can be transmitted in several ways. The risk 
factors for HIV transmission vary according to category: 

• Sexual contact. Persons at greatest risk are those who 
do not practice safe sex, are not monogamous, partici- 
pate in anal intercourse, and have sex with a partner 
with symptoms of advanced HIV infection and/or 
other sexually transmitted diseases (STDs). In the 
United States and Europe, most cases of sexually 
transmitted HIV infection have resulted from homo- 
sexual contact, whereas in Africa, the disease is 
spread primarily through sexual intercourse among 

• Transmission in pregnancy. High-risk mothers include 
women married to bisexual men or men who have an ab- 


Because the immune system cells are destroyed by the AIDS virus, many different types of infections and cancers can de- 
velop, taking advantage of a person’s weakened immune system. (Illustration by Electronic Illustrators Group. The Gale Group.) 

normal blood condition called hemophilia and require 
blood transfusions, intravenous drug users, and women 
living in neighborhoods with a high rate of HIV infection 
among heterosexuals. The chances of transmitting the dis- 
ease to the child are higher in women in advanced stages 
of the disease. Breast feeding increases the risk of trans- 
mission by 10-20% and is not recommended. The use of 
zidovudine (AZT) during pregnancy and delivery, howev- 
er, can decrease the risk of transmission to the baby. 

• Exposure to contaminated blood or blood products. 
With the introduction of blood product screening in the 
mid-1980s, the incidence of HIV transmission in blood 
transfusions has dropped to 1 in 100,000. 

• Needle sticks among health care professionals. Present 
studies indicate that the risk of HIV transmission by a 
needle stick is about 1 in 250. This rate can be de- 
creased if the injured worker is given AZT or triple 
therapy (HAART), the current standard. 


HIV is not transmitted by handshakes or other casu- 
al non-sexual contact, coughing or sneezing, or by 
bloodsucking insects such as mosquitoes. 

AIDS in women 

AIDS in women is a serious public health concern. 
Women exposed to HIV infection through heterosexual 
contact are the most rapidly growing risk group in the 
United States. The percentage of AIDS cases diagnosed 
in women has risen from 7% in 1985 to 18% in 1996. 
For unknown reasons, women with AIDS do not live as 
long as men with AIDS. 

AIDS in children 

Because AIDS can be transmitted from an infected 
mother to her child during pregnancy, during the birth 
process, or through breast milk, all infants born to HIV- 




Kaposi’s sarcoma an AIDS-related cancer, usually appears 
on the lower extremities, as evidenced on this patient’s hip. 

(Custom Medical Stock Photo. Reproduced by permission.) 

positive mothers are at risk. As of 1997, it was estimated 
that 84% of HIV-positive women are of childbearing 
age; 41% of them are drug abusers. Between 15-30% of 
children born to HIV-positive women will be infected 
with the virus. 

AIDS is one of the 10 leading causes of death in 
children between one and four years of age worldwide. 
The interval between exposure to HIV and the develop- 
ment of AIDS is shorter in children than in adults. In- 
fants infected with HIV have a 20-30% chance of devel- 
oping AIDS within a year and dying before age three. In 
the remainder, AIDS progresses more slowly; the aver- 
age child patient survives to seven years of age. Some 
survive into early adolescence. 

Causes & symptoms 

Because HIV destroys immune system cells, AIDS 
is a disease that can affect any of the body’s major organ 
systems. HIV attacks the body through three disease 
processes: immunodeficiency, autoimmunity, and ner- 
vous system dysfunction. 

Immunodeficiency describes the condition in which 
the body’s immune response is damaged, weakened, or 
is not functioning properly. In AIDS, immunodeficiency 
results from the way that the virus binds to a protein 
called CD4, which is found on certain white blood cells, 
including helper T cells, macrophages, and monocytes. 
Once HIV attaches to an immune system cell, it can 
replicate within the cell and kill the cell. In addition to 
killing some lymphocytes directly, the AIDS virus dis- 
rupts the functioning of other CD4 cells. Because the im- 
mune system cells are destroyed, infections and cancers 
that take advantage of a person’s weakened immune sys- 
tem (opportunistic) can develop. 


Autoimmunity is a condition in which the body’s 
immune system produces antibodies that work against its 
own cells. Antibodies are specific proteins produced in 
response to exposure to a specific, usually foreign, pro- 
tein or particle called an antigen. In this case, the body 
produces antibodies that bind to blood platelets that are 
necessary for proper blood clotting and tissue repair. 
Once bound, the antibodies mark the platelets for re- 
moval from the body, and they are filtered out by the 
spleen. Some AIDS patients develop a disorder, called 
immune-related thrombocytopenia purpura (ITP), in 
which the number of blood platelets drops to abnormally 
low levels. 

The course of AIDS generally progresses through 
three stages, although not all patients will follow this 
progression precisely: 

Acute retroviral syndrome 

Acute retroviral syndrome is a term used to describe 
a group of symptoms that can resemble mononucleosis 
and that may be the first sign of HIV infection in 50- 
70% of all patients and 45-90% of women. The symp- 
toms may include fever, fatigue, muscle aches, loss of 
appetite, digestive disturbances, weight loss, skin 
rashes, headache, and chronically swollen lymph nodes 
(lymphadenopathy). Approximately 25-33% of patients 
will experience a form of meningitis during this phase, 
in which the membranes that cover the brain and spinal 
cord become inflamed. Acute retroviral syndrome devel- 
ops between one and six weeks after infection and lasts 
two to four weeks, sometimes up to six weeks. Blood 
tests during this period will indicate the presence of virus 
(viremia) and the appearance of the viral p24 antigen in 
the blood. 

Latency period 

After the HIV virus enters a patient’s lymph nodes 
during the acute retroviral syndrome stage, the disease 
becomes latent for as many as 10 years or more before 
symptoms of advanced disease develop. During latency, 
the virus continues to replicate in the lymph nodes, where 
it may cause one or more of the following conditions. 


(PGL). Persistent generalized lymphadenopathy, or PGL, 
is a condition in which HIV continues to produce chronic 
painless swellings in the lymph nodes during the latency 
period. The lymph nodes most frequently affected by PGL 
are those in the areas of the neck, jaw, groin, and armpits. 
PGL affects between 50-70% of patients during latency. 

develop low-grade fevers, chronic fatigue, and general 
weakness. HIV also may cause a combination of food 


malabsorption, loss of appetite, and increased metabo- 
lism that contribute to the so-called AIDS wasting or 
wasting syndrome. 

OTHER ORGAN SYSTEMS. At any time during the 
course of HIV infection, patients may suffer from a 
yeast infection in the mouth called thrush, open sores or 
ulcers, or other infections of the mouth; diarrhea and 
other gastrointestinal symptoms that cause malnutrition 
and weight loss; diseases of the lungs and kidneys; and 
degeneration of the nerve fibers in the arms and legs. 
HIV infection of the nervous system leads to general loss 
of strength, loss of reflexes, and feelings of numbness or 
burning sensations in the feet or lower legs. 

La t e-stage AIDS 

Late-stage AIDS usually is marked by a sharp de- 
cline in the number of CD4+ lymphocytes (a type of 
white blood cell), followed by a rise in the frequency of 
opportunistic infections and cancers. Doctors monitor 
the number and proportion of CD4+ lymphocytes in the 
patient’s blood in order to assess the progression of the 
disease and the effectiveness of different medications. 
About 10% of infected individuals never progress to this 
overt stage of the disease. 

CD4+ lymphocyte count falls below 200 cells/mm 3 , he 
or she is at risk for opportunistic infections. The infec- 
tious organisms may include: 

• Fungi. Fungal infections include a yeast infection of 
the mouth (candidiasis or thrush) and cryptococcal 

• Protozoa. The most common parasitic disease associat- 
ed with AIDS is Pneumocystis carinii pneumonia 
(PCP). About 70-80% of AIDS patients will have at 
least one episode of PCP prior to death. PCP is the im- 
mediate cause of death in 15-20% of AIDS patients. It 
is an important measure of a patient’s prognosis. Toxo- 
plasmosis is another common infection in AIDS pa- 
tients that is caused by a protozoan. Other diseases in 
this category include amebiasis and cryptosporidiosis. 

• Mycobacteria. AIDS patients may develop tuberculo- 
sis or MAC infections. MAC infections are caused by 
Mycobacterium avium-intracellulare, and occur in 
about 40% of AIDS patients. 

• Bacteria. AIDS patients are likely to develop bacterial 
infections of the skin and digestive tract. 

• Viruses. AIDS patients are highly vulnerable to cy- 
tomegalovirus (CMV), herpes simplex virus (HSV), 
varicella zoster virus (VZV), and Epstein-Barr virus 
(EBV) infections. Another virus, JC virus, causes pro- 
gressive destruction of brain tissue in the brain stem, 





Australia & New Zealand 




East Asia & Pacific 


Eastern Europe & Central Asia 


Latin America 


North Africa & Middle East 


North America 


South & Southeast Asia 


Sub-Saharan African 


Western Europe 


Global total 


cerebrum, and cerebellum (multifocal leukoen- 
cephalopathy or PML), which is regarded as an AIDS- 
defining illness by the Centers for Disease Control and 

PLICATIONS. AIDS dementia complex is a late complica- 
tion of the disease. It is unclear whether it is caused by the 
direct effects of the virus on the brain or by intermediate 
causes. AIDS dementia complex is marked by loss of rea- 
soning ability, loss of memory, inability to concentrate, 
apathy and loss of initiative, and unsteadiness or weakness 
in walking. Some patients also develop seizures. 

late-stage AIDS may develop inflammations of the mus- 
cles, particularly in the hip area, and may have arthritis- 
like pains in the joints. 

ORAL SYMPTOMS. Patients may develop a condition 
called hairy leukoplakia of the tongue. This condition 
also is regarded by the CDC as an indicator of AIDS. 
Hairy leukoplakia is a white area of diseased tissue on 
the tongue that may be flat or slightly raised. It is caused 
by the Epstein-Barr virus. 

AIDS-RELATED CANCERS. Patients with late-stage 
AIDS may develop Kaposi’s sarcoma (KS), a skin tumor 
that primarily affects homosexual men. KS is the most 
common AIDS -related malignancy. It is characterized by 
reddish-purple blotches or patches (brownish in African- 
Americans) on the skin or in the mouth. About 40% of 




patients with KS develop symptoms in the digestive tract 
or lungs. KS appears to be caused by a herpes virus. 

The second most common form of cancer in AIDS 
patients is a tumor of the lymphatic system (lymphoma). 
AIDS -related lymphomas often affect the central ner- 
vous system and develop very aggressively. 

Invasive cancer of the cervix is an important diag- 
nostic marker of AIDS in women. 


Because HIV infection produces such a wide range 
of symptoms, the CDC has drawn up a list of 34 condi- 
tions regarded as defining AIDS. The physician will use 
the CDC list to decide whether the patient falls into one 
of these three groups: 

• definitive diagnoses with or without laboratory evi- 
dence of HIV infection 

• definitive diagnoses with laboratory evidence of HIV 

• presumptive diagnoses with laboratory evidence of 
HIV infection 

Physical findings 

Almost all symptoms of AIDS can occur with other 
diseases. The general physical examination may range 
from normal findings to symptoms that are closely asso- 
ciated with AIDS. These symptoms are hairy leukoplakia 
of the tongue and Kaposi’s sarcoma. When the doctor 
examines the patient, he or she will look for the overall 
pattern of symptoms rather than any one finding. 

Laboratory tests for HIV infection 

BLOOD TESTS (SEROLOGY). The first blood test for 
AIDS was developed in 1985. At present, patients who 
are being tested for HIV infection usually are given an 
enzyme-linked immunosorbent assay (ELISA) test for 
the presence of HIV antibody in their blood. Positive 
ELISA results then are tested with a Western blot or im- 
munofluorescence (1FA) assay for confirmation. The 
combination of the ELISA and Western blot tests is more 
than 99.9% accurate in detecting HIV infection within 
four to eight weeks following exposure. The polymerase 
chain reaction (PCR) test can be used to detect the pres- 
ence of viral nucleic acids in the very small number of 
HIV patients who have false-negative results on the 
ELISA and Western blot tests. In 2003, a one-step test 
that was quicker and cheaper was shown effective for de- 
tecting HIV in the physician office setting. However, fur- 
ther research was ongoing as to its effectiveness in re- 
placing current tests as a first check for HIV. 


OTHER LABORATORY TESTS. In addition to diagnos- 
tic blood tests, there are other blood tests that are used to 
track the course of AIDS. These include blood counts, 
viral load tests, p24 antigen assays, and measurements of 
(3 2 -microglobulin ((3 2 M). 

Doctors will use a wide variety of tests to diagnose 
the presence of opportunistic infections, cancers, or 
other disease conditions in AIDS patients. Tissue biop- 
sies, samples of cerebrospinal fluid, and sophisticated 
imaging techniques, such as magnetic resonance imag- 
ing (MRI) and computed tomography scans (CT) are 
used to diagnose AIDS-related cancers, some oppor- 
tunistic infections, damage to the central nervous sys- 
tem, and wasting of the muscles. Urine and stool sam- 
ples are used to diagnose infections caused by parasites. 
AIDS patients also are given blood tests for syphilis and 
other sexually transmitted diseases. 

Diagnosis in children 

Diagnostic blood testing in children older than 18 
months is similar to adult testing, with ELISA screening 
confirmed by Western blot. Younger infants can be diag- 
nosed by direct culture of the HIV virus, PCR testing, 
and p24 antigen testing. 

In terms of symptoms, children are less likely than 
adults to have an early acute syndrome. They are, how- 
ever, likely to have delayed growth, a history of frequent 
illness, recurrent ear infections, a low blood cell count, 
failure to gain weight, and unexplained fevers. Children 
with AIDS are more likely to develop bacterial infec- 
tions, inflammation of the lungs, and AIDS-related brain 
disorders than are HIV-positive adults. 


AIDS patients turn to alternative medicine when 
conventional treatments are ineffective, and to supple- 
ment conventional treatment, reduce disease symptoms, 
counteract drug effects, and improve quality of life. Be- 
cause alternative medicines may interact with conven- 
tional medicines, it is important for the patient to inform 
his or her doctor of all treatments being used. 

A report released in 2003 showed trends in in- 
creased use of alternative medicine among HIV-positive 
individuals. Based on 1997 figures, the study reported 
that 79% of those seeking alternative therapy to help 
with AIDS treatment or symptom relief were men and 
63% were women. The types of therapies they used most 
were relaxation techniques, massage, chiropractic care, 
self-help groups, commercial diets, and acupuncture. 


• Laurie oils (coconut oil) are used by the body to make 
monolaurin, which inactivates HIV. 


• Selenium deficiency increases the risk of death due to 
AIDS-related illness. One study found that 250 micro- 
grams of selenomethionin daily for one year showed no 
improvement in CD4 cell counts or disease symptoms. 
Greater than 1,000 micrograms daily is toxic. 

• Vitamin C has antioxidant and antiretroviral activities. 
One study found that treatment caused a trend to de- 
crease viral load. 

• DHEA (dehydroepiandrosterone) is commonly used by 
AIDS patients to counteract wasting. One study found 
that DHEA had no effect on lymphocytes or p24 anti- 
gen levels. However, a 2002 study found that it was as- 
sociated with a significant increase in measures that in- 
dicate mental health improvement. 

• Vitamin A deficiency is associated with increased mor- 
tality. One study of pregnant women with AIDS found 
that 5000 IU of vitamin A daily led to stabilized viral 
load as compared to a placebo group. Another study 
found that 60 mg of vitamin A had no effect on CD4 
cells or viral load. Vitamin A has been associated with 
faster disease progression. Excessive vitamin A during 
pregnancy can cause birth defects. 

• Beta-carotene supplementation for AIDS is controver- 
sial as studies have shown both beneficial and detri- 
mental effects. Beta-carotene supplementation has led 
to elevation in white blood cell counts and changes in 
the CD4 cell count. Some studies have found that beta- 
carotene supplementation led to an increase in deaths 
due to cancer and heart disease. 

Naturopathic doctors often recommend the follow- 
ing supplements for AIDS: 

• beta-carotene, 150,000 IU daily 

• vitamin C, 2,000 mg thrice daily 

• vitamin E, 400 IU twice daily 

• cod liver oil, 1 tablespoon daily 

• multivitamin, as directed 

• coenzyme Q 10 , 50-60 mg twice daily 

Herbals and Chinese medicine 

One small study of the effectiveness of Chinese 
herbal treatment in AIDS showed promise. AIDS pa- 
tients took a tablet that contained 31 herbs that was 
based on the formulas Enhance and Clear Heat. Disease 
symptoms were reduced in the herbal treatment group as 
compared to the placebo group. 

Herbals used in treating AIDS include: 

• Maitake mushroom extract. Recommended dose is 10 
drops twice daily 


• Licorice ( Glycyrrhiza glabra ) solid extract. Recom- 
mended dose is one quarter to one half teaspoon twice 

• Boxwood extract (SPV-30) has antiviral activity. Rec- 
ommended dose is one capsule thrice daily. 

• Garlic concentrate (Allicin) helped reduce bowel 
movements, stabilized or increased body weight, or 
cured Cryptosporidium parvum infection in affected 
AIDS patients. However, a 2002 National Institutes of 
Health study cautioned that garlic supplements could 
reduce levels of a protease inhibitor that is used to treat 
AIDS patients, so patients should discuss using garlic 
supplements with their physicians. 

• Tea tree oil ( Malaleuca ) improves or cures infection of 
the mouth by the yeast Candida. Tea tree oil is avail- 
able as soap, dental floss, toothpick, and mouthwash. 

• Marijuana is used to treat wasting. Studies have found 
that patients who use marijuana had increased food in- 
take and weight gain. The active ingredient delta-9- 
tetrahydrocannabinol is licensed for treating AIDS 

Psychotherapy and stress reduction 

Many therapies that are directed at improving men- 
tal state can have a direct impact on disease severity and 
quality of life. The effectiveness of many have been 
proven in clinical studies. These include: 

• massage 

• laughter/humor 

• stress management training 

• visualization 

• cognitive therapy 

• aerobic exercise 

• prayer 

Other treatments for AIDS include homeopathy, 
naturopathy, acupuncture, and chiropractic. 

Allopathic treatment 

Treatment for AIDS covers four categories: 

Antiretroviral treatment 

In recent years researchers have developed drugs 
that suppress HIV replication. The drugs are used in 
combination with one another and fall into four classes: 

• Nucleoside reverse transcriptase inhibitors. These drugs 
work by interfering with the action of HIV reverse tran- 
scriptase, thus ending the virus replication process. 
These drugs include zidovudine (sometimes called Zi- 




dovudine or AZT, trade name Retrovir), didanosine 
(ddi, Videx), emtricitabine (FTC, Emtriva), zalcitabine 
(ddC, Hivid), stavudine (d4T, Zerit), abacavir (Ziagen), 
tenofovir (df, Viread), and lamivudine (3TC, Epivir). 

• Protease inhibitors. Protease inhibitors are effective 
against HIV strains that have developed resistance to 
nucleoside analogues, and often are used in combina- 
tion with them. These compounds include saquinavir 
(Fortovase), ritonavir (Norvir), indinavir (Crixivan), 
amprenavir (Agenerase), lopinavir plus ritonavir (Rey- 
ataz), and nelfinavir (Viracept). 

• Non-nucleoside reverse transcriptase inhibitors. This is 
a newer class of antiretroviral agents. Three are avail- 
able, nevirapine (Viramune), efavirenz (Sustiva), and 
delavirdine (Rescript or). 

• Fusion inhibitors. These drugs are less common, ex- 
pensive and difficult to use. They block infection early 
by preventing HIV from fusing with and entering a 
human cell. This class includes only one compound: 
Enfuvirtide (Fuzeon). 

Treatment guidelines for these agents are in constant 
change as new medications are developed and intro- 
duced. In mid-2003, the U.S. Department of Health and 
Human Services revised its guidelines for the use of 
these agents to help clinicians better choose the best 
combinations. The new guidelines offer a list of suggest- 
ed combination regimens classified as either “preferred” 
or “alternative”. 

Treatment of opportunistic infections 

and malignancies 

Most AIDS patients require complex long-term 
treatment with medications for infectious diseases. This 
treatment often is complicated by the development of re- 
sistance in the disease organisms. AIDS-related malig- 
nancies in the central nervous system usually are treated 
with radiation therapy. Cancers elsewhere in the body 
are treated with chemotherapy. 

Prophylactic treatment for opportunistic infections 

Prophylactic treatment is treatment that is given to 
prevent disease. AIDS patients with a history of Pneu- 
mocystis pneumonia; with CD4+ counts below 200 
cells/mm 3 or 14% of lymphocytes; weight loss; or thrush 
should be given prophylactic medications. The three 
drugs given are trimethoprim-sulfamethoxazole, dap- 
sone, or pentamidine in aerosol form. 

cause many patients with AIDS suffer from abnormally 
low levels of both red and white blood cells, they may be 
given medications to stimulate blood cell production. 


Epoetin alfa (erythropoietin) may be given to anemic pa- 
tients. Patients with low white blood cell counts may be 
given filgrastim or sargramostim. 

Treatment in women 

Treatment of pregnant women with HIV is particu- 
larly important because antiretroviral therapy has been 
shown to reduce transmission to the infant by 65%. 

Expected results 

At the present time, there is no cure for AIDS. Treat- 
ment stresses aggressive combination drug therapy when 
possible. The use of multi-drug therapies has significant- 
ly reduced the number of U.S. deaths resulting from 
AIDS. The potential exists to possibly prolong life indef- 
initely using these and other drug therapies to boost the 
immune system, keep the virus from replicating, and 
ward off opportunistic infections and malignancies. 

Prognosis after the latency period depends on the 
patient’s specific symptoms and the organ systems af- 
fected by the disease. Patients with AIDS-related lym- 
phomas of the central nervous system die within two to 
three months of diagnosis; those with systemic lym- 
phomas may survive for eight to ten months. In America, 
the successful treatment of AIDS patients with HAART 
has actually led to a growing number of people living 
with HIV. About 25,000 infected people per year are 
added to the list of HIV-infected Americans. 

However, not only does HAART and other treat- 
ment prolong AIDS patients’ lives, it has led to some im- 
provement in quality of life too. A recent study shows 
that HAART therapy substantially reduces risk of AIDS- 
related pneumonia (PCP), although PCP still remains the 
most common AIDS-defining illness among opportunis- 
tic infections. Other recent studies show that these pro- 
tease inhibitors may result in high cholesterol and put 
AIDS patients at eventual risk for heart disease. Further 
research must be done, since long-term effects of 
HAART treatment are just now being studied. Most clin- 
icians would say the benefits outweigh the risks anyway. 


As of 2000, there is no vaccine effective against 
AIDS. Several vaccines to prevent initial HIV infection 
and disease progression are being tested. In 2002, reports 
showed a new “library” vaccine showed potential. The 
vaccine is composed of up to 32 HIV gene fragments 
that can induce a number of immune responses. In the 
same year, the British government worked with five 
African countries in a trial to find an effective gel that 
would protect women against HIV during sex. The study 


leaders believed if they could find a lotion that could be 
applied before intercourse that would help prevent HIV 
transmission, they would give women the ability to bet- 
ter protect themselves from HIV. In 2003, the first 
human test of a vaccine against the most common sub- 
type of HIV was underway. 

Precautions to take to prevent the spread of AIDS 

• Monogamy and practicing safe sex. Besides avoiding 
the risk of HIV infection, condoms are successful in 
preventing other sexually transmitted diseases and un- 
wanted pregnancies. 

• Avoiding needle sharing among intravenous drug users. 

• Although blood and blood products are carefully moni- 
tored, those individuals who are planning to undergo 
major surgery may wish to donate blood ahead of time 
to prevent a risk of infection from a blood transfusion. 

• Healthcare professionals should wear gloves and masks 
when handling body fluids and avoid needle-stick in- 

• A person who suspects that he or she may have become 
infected should get tested. If treated aggressively and 
early, the development of AIDS can sometimes be post- 
poned indefinitely. If HIV infection is confirmed, it 
also is vital to inform sexual partners. 



Abrams, Donald I. "Alternative Therapies.” AIDS Therapy. 
edited by Raphael Dolin et al. Philadelphia: Churchill 
Livingstone, 1999. 

Early HIV Infection Guideline Panel. Evaluation and Manage- 
ment of Early HIV Infection. Rockville, MD: U.S. Depart- 
ment of Health and Human Services, Agency for Health 
Care Policy and Research, 1994. 

The Global AIDS Policy Coalition. AIDS in the World. Cam- 
bridge, MA: Harvard University Press, 1992. 

Huber, Jeffrey T. Dictionary of AIDS-Related Terminology. 
New York and London: Neal-Schuman Publishers, Inc., 

"Infectious Diseases: Human Immunodeficiency Virus (HIV).” 
In Neonatology: Management, Procedures, On-Call Prob- 
lems, Diseases and Drugs, edited by Tricia Lacy Gomella, 
et al. Norwalk, CT: Appleton & Lange, 1994. 

Katz, Mitchell H. and Harry Hollander. "HIV Infection.” In 
Current Medical Diagnosis & Treatment 1998. edited by 
Lawrence M. Tierney Jr., et al. Stamford, CT: Appleton & 
Lange, 1998. 

McCutchan, J. Allen. "Alternative, Unconventional, and Un- 
proven Therapies.” Textbook of AIDS Medicine, 2nd edi- 
tion. edited by Thomas C. Merigan, et al. Baltimore: 
Williams & Wilkins, 1999. 

McFarland, Elizabeth J. “Human Immunodeficiency Virus 
(HIV) Infections: Acquired Immunodeficiency Syndrome 


(AIDS).” In Current Pediatric Diagnosis & Treatment. 
edited by William W. Hay Jr., et al. Stamford, CT: Apple- 
ton & Lange, 1997. 

So, Peter and Livette Johnson. "Acquired Immune Deficiency 
Syndrome (AIDS).” In Conn's Current Therapy, edited by 
Robert E. Rakel. Philadelphia: W. B. Saunders Company, 

Standish, Leanna J., Roberta C.M. Wines, and Cherie Reeves. 
“Complementary/Alternative Therapies in Select Popula- 
tions: Women with HIV and AIDS.” In Complementary / 
Alternative Medicine: An Evidence Based Approach, edit- 
ed by John W. Spencer and Joseph J. Jacobs. St. Louis: 
Mosby, 1999. 


“DHEA in HIV Infection.” Infectious Disease Alert. (March 1 . 

2002) : S7. 

Ernst, Jerome. “Alternative Treatment Modalities in Human 
Immunodeficiency Virus/Acquired Immune Deficiency 
Syndrome.” Clinical Infectious Diseases (September 1, 

2003) : 150-154. 

"First Human Tests Under Way of HIV Vaccine Pioneered at 
UNC.” AIDS Vaccine Week (August 25, 2003): 2. 

Fleck, Fiona. "British Medical Journal.” British Medical Jour- 
nal (September 27, 2003): 698. 

Gangel, Elaine K. "Garlic Supplements and HIV Medication.” 
American Family Physician (March 15, 2002): 1225. 

“Government Lauches Trial of Gel to Protect Women Against 
HIV.” AIDS Weekly (March 25, 2002): 11. 

"HIV Drugs Approved as of August 2003.” AIDS Treatment 
News (July 25, 2003): 4. 

"HIV Rising Among Gay, Bisexual Men.” Medical Letter on 
the CDC & FDA (August 24, 2003): 9. 

"Is HAART Hard on the Heart” Science News (March 9, 2002): 

"Library Vaccine Shows Promise.” Vaccine Weekly. (February 
13, 2002): 2. 

"One-step HIV Test May Be Cheaper. Faster, Less Wasteful.” 
AIDS Weekly (September 29, 2003): 13. 

Ozsoy, Metin and Edzard Ernst. "How Effective are Comple- 
mentary Therapies for HIV and AIDS? — a Systematic Re- 
view.” International Journal of STD & AIDS 10 (1999): 
629- 635. 

"Prevalence of HIV Infection Increasing in Older Americans.” 
AIDS Weekly (September 1, 2003): 16. 

"Revised Guidelines Will Ease Selection of HIV/AIDS Treat- 
ments.” Drug Week (August 8, 2003): 10. 

“Successful HAART Reduces Risk of Pneumonia.” AIDS 
Weekly (January 14, 2002): 24. 

“Success of Treatment Swells Ranks of HIV Infected.” AIDS 
Weekly (March 25, 2002): 13. 

Wootton, Jacqueline C. “Web Watch: Alternative and Comple- 
mentary Therapies.” AIDS Patient Care and STDs 12 
(1998): 811-813. 


American Foundation for AIDS Research, 733 Third Avenue, 
12th floor, 1515 Broadway, Suite 3601, New York, NY 
10017. (212) 682- 7440. 





Acute retroviral syndrome — A group of symptoms 
resembling mononucleosis that often are the first 
sign of HIV infection. 

AIDS dementia complex — A type of brain dysfunction 
caused by HIV infection that causes difficulty thinking, 
confusion, and loss of muscular coordination. 

Antibody — A specific protein produced by the im- 
mune system in response to a specific foreign pro- 
tein or particle called an antigen. 

Antigen — Any substance that stimulates the body 
to produce antibody. 

Autoimmunity — A condition in which the body's 
immune system produces antibodies in response to 
its own tissues or blood components instead of to 
foreign particles or microorganisms. 

CD4 — A type of protein molecule in human blood. 
The HIV virus infects cells with CD4 surface pro- 
teins, and as a result, depletes the number of T 
cells, B cells, natural killer cells, and monocytes in 
the patient's blood. 

Hairy leukoplakia of the tongue — A white area of 
diseased tissue on the tongue that may be flat or 
slightly raised. It is caused by the Epstein-Barr virus 
and is an important diagnostic sign of AIDS. 

Hemophilia — Hereditary blood clotting disorders 
occurring almost exclusively in males. 

Human immunodeficiency virus (HIV) — A trans- 
missible retrovirus that causes AIDS in humans. Two 
forms of HIV are now recognized: HIV-1, which 
causes most cases of AIDS in Europe, North and 
South America, and most parts of Africa; and HIV-2, 
which is chiefly found in West African patients. 

Immunodeficient — A condition in which the 
body's immune response is damaged, weakened, 
or is not functioning properly. 

Kaposi's sarcoma — A cancer of the connective tis- 
sue that produces painless purplish red (in people 
with light skin) or brown (in people with dark skin) 
blotches on the skin. It is a major diagnostic mark- 
er of AIDS. 

Latent period — Also called incubation period, the 
time between infection with a disease-causing 
agent and the development of disease. 

Lymphocyte — A type of white blood cell that is im- 
portant in the formation of antibodies and that can 
be used to monitor the health of AIDS patients. 

Lymphoma — A cancerous tumor in the lymphatic 
system that is associated with a poor prognosis in 
AIDS patients. 

Macrophage — A large white blood cell, found pri- 
marily in the bloodstream and connective tissue, 
that helps the body fight off infections by ingesting 
the disease-causing organism. 

Monocyte — A large white blood cell that is formed 
in the bone marrow and spleen. 

Mycobacterium avium (MAC) infection — A type 
of opportunistic infection that occurs in about 40% 
of AIDS patients and is regarded as an AIDS-defin- 
ing disease. 

Opportunistic infection — An infection by organ- 
isms that usually don't cause infection in people 
whose immune systems are working normally. 

Persistent generalized lymphadenopathy (PGL) — 

A condition in which HIV continues to produce 
chronic painless swellings in the lymph nodes dur- 
ing the latency period. 

Pneumocystis carinii pneumonia (PCP) — An op- 
portunistic infection caused by a fungus that is a 
major cause of death in patients with late-stage 

Progressive multifocal leukoencephalopathy 
(PML) — A d isease caused by a virus that destroys 
white matter in localized areas of the brain. It is re- 
garded as an AIDS-defining illness. 

Protozoan — A single-celled, usually microscopic 
organism that has a nucleus and is, therefore differ- 
ent from bacteria. 

Retrovirus — A virus that contains a unique enzyme 
called reverse transcriptase that allows it to repli- 
cate within new host cells. 

T cells — Lymphocytes that originate in the thymus 
gland. CD4 lymphocytes are a subset of T lympho- 

Thrush — A yeast infection of the mouth character- 
ized by white patches on the inside of the mouth 
and cheeks. 

Viremia — The measurable presence of virus in the 
bloodstream that is a characteristic of acute retro- 
viral syndrome. 

Wasting syndrome — A progressive loss of weight 
and muscle tissue caused by the AIDS virus. 



Gay Men's Health Crisis, Inc., 129 West 20th Street, New 
York, NY 10011-0022. (212) 807-6655. 

National AIDS Hot Line. (800) 342-AIDS (English). (800) 344- 
SIDA (Spanish). (800) AIDS-TTY (hearing-impaired). 

Belinda Rowland 
Teresa G. Odle 



Alcoholism is the layman’s term for alcohol depen- 
dence and alcohol abuse. According to the Diagnostic and 
Statistical Manual of Mental Disorders, published by the 
American Psychiatric Association and commonly called the 
DSM-IV, the essential feature of substance abuse (in this in- 
stance, alcohol abuse) is maladaptive use of the substance 
with recurrent and significant adverse consequences related 
to its repeated use. Dependence is a physical addiction with 
psychological, social and genetic components. Despite 
damage to health, finances, reputations, and relationships, 
the alcohol dependent person will continue to drink unless 
an intervention occurs. Abuse, distinguished from depen- 
dence by retaining some control over the use of alcohol, 
nevertheless carries many of the same consequences over 
time, and certainly increases risk of dependence. 

Today, alcohol abuse and alcohol dependence are 
often associated with abuse of, or dependence on, other 
substances including nicotine, marijuana, cocaine, 
heroin, amphetamines, sedatives, and anxiolytics (anti- 
anxiety drugs). Alcoholism is more common in males 
than in females, with an estimated male-to-female ratio 
as high as five-to-one. A United States study conducted 
between 1990 and 1991, using DSM standards, found 
that 14% of the adult population (ages 15-54) had, at 
some time, met the criteria for alcohol dependence; and 
7% had been alcohol-dependent in the past year. An ear- 
lier, similar study showed that about 5% of Americans 
qualified for a diagnosis of alcohol abuse at some point 
during their life. According to a 2002 report by the Na- 
tional Council on Alcoholism and Drug Dependence, 14 
million Americans abuse alcohol, and 100,000 die annu- 
ally of alcohol related preventable causes. Though it is 
difficult to develop accurate statistics worldwide, it is 
known that the incidence of what we call alcoholism has 
been steadily rising around the globe for several years. 


The effects of alcoholism are quite far-reaching. Al- 
coholism affects every body system, causing a wide 


range of drinking related health problems, including 
lower testosterone, shrinking gonads, erectile dysfunc- 
tion, interference with reproductive fertility, weak bones, 
memory disorders, difficulty with balance and walking, 
liver disease (including cirrhosis and hepatitis), high 
blood pressure, weakness of muscles (including the 
heart), disturbances of heart rhythm, anemia, clotting 
disorders, weak immunity to infections, inflammation 
and irritation of the entire gastrointestinal system, acute 
and chronic problems with the pancreas, low blood 
sugar, high blood fat content, and poor nutrition. 

Its mental health implications include marital and 
other relationship difficulties, depression, unemploy- 
ment, poor performance at school or work, spouse and 
child abuse, and general family dysfunction. Alcoholism 
causes or contributes to a variety of severe social prob- 
lems: homelessness, murder, suicide, injury, and violent 
crime. Alcohol is a contributing factor in 50% of all 
deaths from motor vehicle accidents. In fact, 50% of the 
100,000 deaths that occur each year due to the effects of 
alcohol are due to injuries of some sort. Alcohol costs 
the United States over $150 billion yearly in lost produc- 
tivity and alcohol related medical expense. 

Causes & symptoms 

A physical dependence on alcohol develops insidi- 
ously, over time. The body is a magnificent adaptor; 
therefore, with persistent use, many adaptations occur 
physically and psychologically, resulting in both a higher 
tolerance to and increased need for alcohol — craving it — 
The physical adaptation to alcohol involves changing lev- 
els and altered balances of neuro transmitters, chemicals 
in the brain which not only affect physical abilities like 
muscle coordination, but also mood. The abuse of alcohol 
is associated with a desire to feel better and to avoid feel- 
ing poorly. Initially a stimulant, it eventually acts as a 
central nervous system (CNS) depressant and is used in a 
majority of societies or cultures in the world as an accept- 
ed part of dealing with life events, except where religious 
opposition bans, discourages or prohibits its use, as in 
most Muslim communities. It is included in celebrations 
and, ironically, its use is perceived as an appropriate re- 
sponse to sadness and loss, such as at wakes. 

There is, at this point, no single known factor that 
causes some people to be alcohol-dependent and others 
not. Recent genetic studies have demonstrated that close 
biological relatives of an alcoholic are four times more 
likely to become alcoholics themselves. Furthermore, 
this risk holds true even for children who were adopted 
away from their biological families at birth and raised in 
non-alcoholic homes, without knowledge of their biolog- 
ical family’s difficulties with alcohol. Male gender, 




BAC (%) 



Mood elevation; slight muscle relaxation 


Relaxation and warmth; increased reaction time; decreased fine muscle coordination 


Impaired balance, speech, vision, hearing, and muscle coordination; euphoria 


Gross impairment of physical and mental control 


Severely intoxicated; very little control of mind or body 


Unconscious; deep coma; death from respiratory depression 

being the child of an alcoholic parent or parents, extend- 
ed family history and being of Irish (Celtic), Scandina- 
vian, German, Polish, Russian or Native American an- 
cestry, beginning drinking as a teenager, and being de- 
pressed or highly anxious all increase the risk of experi- 
encing problems with alcohol. Further research may 
determine if genetic factors are accountable, in part, for 
differences in alcohol metabolism and increase the risk 
of an individual becoming an alcoholic. Other cause re- 
lated factors in alcoholism include high levels of stress 
and turmoil or pain, having drinking friends, drinking 
partners, and “enablers” — people who facilitate a 
drinkers habits and denial mechanisms. Heavy advertis- 
ing that makes drinking appear to be “sexy” or the basis 
of a good time also contributes. Consider, for example, 
the number of televised sporting events that are spon- 
sored heavily by alcohol related enterprises. 

One of the classic symptoms of alcoholism is denial 
of a problem with alcohol. An addicted person, under the 
influence of the addictive substance, is physically and 
psychologically motivated to perpetuate the addiction. 
Therefore, intervention often starts when loved ones, 
recognizing the signs and symptoms, bring attention to 
the problem and call for help. Occasionally, an interven- 
tion requires a whole family unit and outside assistance. 
Signs and symptoms of alcohol dependence and abuse 
may include the following: 

• not remembering conversations or commitments 

• losing interest in activities that were once pleasurable 

• ritualized drinking, before, with, and after dinner and 
being upset if the pattern is interrupted 

• becoming irritable as “happy hour” approaches, espe- 
cially if alcohol is not available 

• drinking alone or secretly 

• hiding alcohol in unusual places 

• ordering doubles, drinking quickly, and drinking to be- 
come drunk, intentionally 


• focusing attention on the source of one’s next drink 

• unstable relationships, financial, legal, and employ- 
ment difficulties 

Physical symptoms of alcoholism can be broken 
into two major categories: symptoms of acute alcohol 
use and symptoms of long-term alcohol use. 

Immediate (acute) effects of alcohol use 

Though the initial reaction to alcohol may be stimu- 
latory, ultimately alcohol exerts a depressive, uninhibit- 
ing effect on the brain. The blood-brain barrier does not 
prevent alcohol from entering the brain, so the brain al- 
cohol level quickly becomes equivalent to the blood al- 
cohol level. Alcohol’s depressive effects result in im- 
paired thinking, feeling and judgment, short term memo- 
ry loss, muscle weakness difficulty walking, poor bal- 
ance, slurring of speech, and generally poor coordination 
(accounting for the increased likelihood of injury and al- 
cohol related injury statistics). At higher alcohol levels, a 
person’s breathing and heart rate slows. Vomiting may 
occur, with a high risk of vomitus “aspiration” (inhaling 
vomit into the lungs), and may result in further compli- 
cations includingpneumonia. Still higher alcohol levels 
may result in coma and death. 

Effects of long-term (chronic) alcoholism 

Alcohol is considered a lethal poison, requiring con- 
tinuous detoxification by the liver. As drinking contin- 
ues and overwhelms the liver’s ability to detoxify, long 
term consequences to health occur, affecting virtually 
every organ system of the body. 

NERVOUS SYSTEM. It is estimated that 30-40% of 
all men in their teens and twenties have experienced al- 
coholic blackout (loss of consciousness) as a result of 
drinking a large quantity of alcohol. In an alcoholic 
blackout, all memory of time and behavior surrounding 
the episode of drinking is lost. Alcohol causes sleep dis- 


turbances, thus affecting overall sleep quality. Numbness 
and tingling may occur in the arms and legs. Two condi- 
tions that may occur either together or separately are 
Wernicke’s and Korsakoff’s syndromes. Both are due to 
the depleted thiamin levels found in alcoholics. Wer- 
nicke’s syndrome results in disordered eye movements, 
very poor balance, and difficulty walking, while Kor- 
sakoff’s syndrome severely affects one’s memory, pre- 
venting new learning from taking place. 

GASTROINTESTINAL SYSTEM. Alcohol causes a loos- 
ening of the muscular ring (the cardiac sphincter) that 
prevents the stomach’s contents from reentering the 
esophagus. As a result, acid from the stomach flows up- 
ward into the esophagus, burning those tissues and caus- 
ing pain and bleeding, or gastro-esophageal reflux dis- 
ease (GERD). Inflammation of the stomach can also re- 
sult in bleeding (ulcers) and pain as well as a decreased 
desire to eat. A major cause of severe, uncontrollable 
bleeding (hemorrhage) in an alcoholic is the develop- 
ment in the esophagus of enlarged (dilated) blood ves- 
sels, which are called esophageal varices (varicose veins 
of the esophagus). These varices actually develop in re- 
sponse to the toxic effect of alcohol on the liver, and are 
extremely prone to bursting and hemorrhage. 

A malnourished state arises from the loss of appetite 
for food — due to caloric substitution of alcohol and its ef- 
fects on blood sugar levels — and interference with the ab- 
sorption of nutrients throughout the intestinal tract. Inflam- 
mation of the pancreas (pancreatitis) is a serious and 
painful problem in alcoholics that disrupts carbohydrate 
and fat digestion, and increases the risk of insulin resis- 
tance, weight gain, hyperlipidemia, diabetes, and pancreat- 
ic cancer. Diarrhea is also a common symptom of chronic 
alcohol use, due to alcohol’s effect on the pancreas. 

LIVER. Because alcohol is broken down (metabo- 
lized) within the liver, that organ is severely affected by 
constant levels of alcohol. Alcohol interferes with the 
large number of important chemical processes that occur 
in the liver. As alcohol converts to blood sugar, which in 
turn converts to blood fat, the liver begins to enlarge, fill- 
ing with fat, a condition called fatty liver. Cirrhosis, a 
potentially deadly complication, develops when fibrous 
tissue, while trying to support the extra burden placed on 
the liver by the accumulation of fat and liver cell weak- 
ness, interferes with the liver’s normal structure and 
function. The liver may also become inflamed, a condi- 
tion called hepatitis, producing jaundice, fatigue, and 
elevated liver enzymes indicative of liver cell death and 
destruction. Because of the liver’s enormous role in di- 
gestion, metabolism and immunity, damage to the liver 
takes a serious toll throughout the body. 

BLOOD. Alcohol can cause changes to any of the 
types of blood cells. Red blood cells become abnormally 


large. White blood cells (important for fighting infec- 
tions) decrease in number, resulting in a weakened im- 
mune system. This places alcoholics at increased risk for 
infections and is thought to account in part for an alco- 
holic’s increased risk of cancer (ten times greater than 
normal). Platelets and blood clotting factors are affected, 
causing an increased risk of bleeding and hemorrhage, 
especially when coupled with vascular weaknesses, 
varices, or aneurism. 

of alcohol cause a drop in blood pressure, but increased 
use begins to raise blood pressure dangerously. Increased 
blood pressure negatively affects the kidneys. While 
some studies demonstrate that one to two alcoholic 
drinks per night improves heart disease risk values, 
higher amounts and chronic intake produce high levels 
of circulating fats, which increases the risk of heart dis- 
ease. Heavy drinking results in an enlarged heart, coro- 
nary arterial disease (CAD), peripheral vascular disease, 
weakening of the heart muscle, abnormal heart rhythms, 
a risk of blood clots forming within the chambers of the 
heart, and a greatly increased risk of stroke. Strokes re- 
sult when a blood clot from the heart enters the circula- 
tory system, goes to the brain, and blocks a blood vessel. 
Stroke may also result from a hemorrhage within the 
brain, as weakened vessel walls give way and platelet de- 
ficient blood pours through. 

REPRODUCTIVE SYSTEM. Heavy drinking has a neg- 
ative effect on fertility in both men and women, decreas- 
ing testicular and ovarian size, interfering with sperm 
and egg production and viability, disrupting menstrual 
cycles, and reducing libido. When pregnancy is 
achieved reduced quality of sperm and egg may signifi- 
cantly and permanently affect the quality of life, pre-, 
peri- and postnatally, of the child. A child born to an al- 
cohol using woman has a great risk of being born with 
fetal alcohol syndrome, which causes distinctive cranial 
and facial defects, including a smaller head size, shorten- 
ing of the eyelids, and a lowered IQ. Developmental dis- 
abilities, heart defects, and behavioral problems are also 
more likely. 


The DSM-IV breaks substance abuse into specific 
criteria that can be of aid in diagnosing a substance 
abuse problem. These criteria are paraphrased here to re- 
late to alcoholism. At least one of the following must 
have manifested itself within a 12-month period to quali- 
fy for a diagnosis of alcohol abuse: 

• Recurrent alcohol use that results in failure to fulfill 
major role obligations at work, school, or home. Spe- 
cific examples are repeated absences from work or 




poor work performance related to alcohol use; alcohol- 
related absences, suspensions, or expulsions from 
school; and neglect of children or household. 

• Recurrent alcohol use in situations in which it is physi- 
cally hazardous. Specific examples are driving an auto- 
mobile and operating a machine while impaired by al- 
cohol use. 

• Recurrent alcohol-related legal problems, such as ar- 
rests for alcohol-related disorderly conduct. 

• Continued alcohol use despite having persistent and re- 
curring social or interpersonal problems caused or ex- 
acerbated by the effects of the alcohol. Examples in- 
clude arguments with a spouse about the consequences 
of intoxication, and alcohol-related physical fights. 

A diagnosis of alcohol dependence requires habitu- 
al, long-term tolerance for and heavy consumption of al- 
cohol as well as the development of symptoms of with- 
drawal when the amount of alcohol in the system is sub- 
stantially lowered or completely stopped. Once a pattern 
of compulsive alcohol use has developed, alcohol-depen- 
dent people may devote large portions of their time to 
the procurement and drinking of alcohol. 

A significant number of illnesses categorized in 
DSM-IV as alcohol-induced disorders has come into 
being as a result of alcohol abuse and dependence, illus- 
trating the negative impacts of alcoholism on physical 
and mental health. Among the psychiatric diagnoses that 
are included in alcohol-induced disorders are: 

• dementia 

• amnestic disorder 

• psychotic disorder 

• mood disorder 

• anxiety disorder 

• sexual dysfunction 

• sleep disorder 

As previously mentioned, due to the strong element 
of denial and a need, usually, for an intervention, diagno- 
sis is often brought about because family members call 
an alcoholic’s difficulties to the attention of a physician. 
A physician may become suspicious when a patient suf- 
fers repeated injuries or begins to experience medical 
problems that are related to the use of alcohol. In fact, 
some estimates suggest that about 20% of a physician’s 
patients are alcoholics, a percentage which is higher than 
the general population and lower than the increased risk 
to health posed by alcoholism. In other words, alcohol 
related illness may prompt an alcoholic to see medical 
counsel, but their illness may not be recognized as alco- 
hol related until the disease toll is quite advanced. 


Questionnaires that try to determine what aspects of 
a person’s life may be affected by use of alcohol can be 
an effective diagnostic aid. Determining the exact quan- 
tity of alcohol that a person drinks is much less impor- 
tant than determining how his or her drinking affects 
health, relationships, jobs, educational goals, and family 
life. In fact, because the metabolism of alcohol (how the 
body breaks down and processes alcohol) is so individ- 
ual, the quantity of alcohol consumed is not part of the 
criteria list for diagnosing either alcohol dependence or 
alcohol abuse. 

One very simple tool for beginning the diagnosis of 
alcoholism is called the CAGE questionnaire. It consists 
of four questions, with the first letter of each key word 
spelling out the word CAGE: 

• Have you ever tried to Cut down on your drinking? 

• Have you ever been Annoyed by anyone’s comments 
about your drinking? 

• Have you ever felt Guilty about your drinking? 

• Do you ever need an Eye-opener (a morning drink of 
alcohol) to start the day? 

Other, longer lists of questions may help determine 
the severity and effects of a person’s alcohol use. A thor- 
ough physical examination may reveal the physical signs 
suggestive of alcoholism, such as an enlarged liver, a vis- 
ible network of enlarged veins just under the skin around 
the navel (called caput medusae) (or herniated umbili- 
cus), fluid in the abdomen (ascites), yellowish tone to the 
skin (jaundice), decreased testicular size or gynecomas- 
tia (breast enlargement in men), osteoporosis, physical 
deterioration, loss of teeth, evidence of old injuries, and 
poor nutritional status. Diagnostic testing may include 
cardiovascular, CNS, GI, general chemistry and liver 
function tests (LFTs) and reveal poor stress test perfor- 
mance, arterial disease, congestive heart failure, palsy, 
loss of coordination, reflux disease or history of stomach 
ulcer, irritable bowel syndrome, an increased red blood 
cell size and anemia, abnormal white blood cells (cells 
responsible for fighting infection) counts or characteris- 
tics, abnormal platelets (particles responsible for clot- 
ting), and increased liver enzymes. Given the genetic 
risk factors for alcoholism, determinations of familiar al- 
coholism related illness and death may be additive. 


Alternative treatments can be a helpful adjunct for 
the alcoholic patient once the medical danger of with- 
drawal has passed. Because many alcoholics have very 
stressful lives (because of, or leading to, the alcoholism), 
many of the treatments for alcoholism involve dealing 
with and relieving stress. These include massage, medi- 


tation, and hypnotherapy. A list from the Mayo Clinic 
also includes acupuncture (may reduce craving, anxi- 
ety, depression, tremor, fatigue, and the symptoms of 
withdrawal), biofeedback (monitoring of internal systems 
for stress reduction), behavioral therapy motivational en- 
hancement therapy (problem acknowledgment), and 
aversion therapy (may involve simultaneous use of med- 
ications the cause nausea or vomiting with relapse.) 

Nutritionally oriented practitioners may be consult- 
ed to address the malnutrition associated with long-term 
alcohol use. Careful and remedial attention toward a 
healthier diet and lifestyle, including use of nutritional 
supplements, such as vitamins A, B complex, and C; cer- 
tain fatty acids; amino acids; zinc; magnesium; and se- 
lenium — supplements that support antioxidant, detoxify- 
ing, restorative and corrective deficiencies — may further 
enhance recovery and lessen the likelihood of relapse. 

Herbal treatments include milk thistle ( Silybum 
marianum ), which is thought to protect the liver against 
damage. Other herbs are thought to be helpful for the pa- 
tient suffering through withdrawal. Some of these in- 
clude the antidepressive attributes of lavender ( Lavan- 
dula officinalis), the calming and restorative nerve toni- 
fying effects of skullcap ( Scutellaria lateriflora), 
chamomile ( Matricaria recutita), and valerian ( Valeri- 
ana officinalis), the stimulating and GI helpful effects of 
peppermint ( Mentha piperita), and the bladder aid, 
yarrow ( Achillea millefolium). 

Allopathic treatment 

Allopathic treatment of alcoholism has two parts. 
The first phase is the treatment of acute effects of alco- 
holism, called detoxification. The second phase involves 
learning how to live with the disease of alcoholism. 


Detoxification, or withdrawal, involves helping the 
person to rid his or her body of alcohol as well as the 
harmful physical effects of the alcohol. Because the per- 
son’s body has become accustomed to alcohol, he or she 
needs care and monitoring during withdrawal. With- 
drawal is an individual experience, depending on the 
severity of the alcoholism as measured by the quantity of 
alcohol ingested daily and the length of time the patient 
has been drinking (the adaptation factor). Withdrawal 
symptoms can range from mild to life threatening. Mild 
withdrawal symptoms include nausea, ache, diarrhea, 
difficulty sleeping, excessive sweating, anxiety, and 
trembling. This phase may last from three to seven days. 
More severe effects of withdrawal may include halluci- 
nations (in which a patient sees, hears, or feels some- 
thing that is not real), seizures, an unbearable craving for 


more alcohol, confusion, fever, fast heart rate, high 
blood pressure, and delirium (a fluctuating level of con- 
sciousness). Patients at highest risk for the most severe 
symptoms of withdrawal (referred to as delirium tremens 
or DTs) are those with other medical problems, such as 
malnutrition, liver disease, or Wernicke’s syndrome. 
Delirium tremens usually begins about three to five days 
after the patient’s last drink and may last a number of 
days. Withdrawal usually progresses from the more mild 
symptoms to the more severe ones. 

Patients going through only mild withdrawal, moni- 
tored carefully to make sure that more severe symptoms 
do not develop, may not require medication, however, 
fluids are encouraged to facilitate detoxifying the per- 
son’s system. Patients suffering more severe effects of 
withdrawal may need to be given sedative medications, 
benzodiazepines like Valium or Librium, to relieve dis- 
comfort and to avoid the potentially life threatening 
complications of high blood pressure, fast heart rate, and 
seizures. Because of the patient’s nausea, fluids may 
need to be given intravenously (through a vein), along 
with some necessary sugars and salts (electrolyte push- 
es). It is crucial that thiamin be included in the fluids, be- 
cause thiamin is usually quite low in alcoholic patients, 
and deficiency of thiamin is responsible for the Wer- 
nicke-Korsakoff syndrome. In-patient treatment is usual- 
ly short-term (three to seven days), though longer reha- 
bilitation programs lasting weeks or even months are 
sometimes needed. Any treatment is usually followed by 
longer-term outpatient treatment. 


After the physical problems associated with alcohol 
withdrawal have been treated, the more difficult task be- 
gins: helping the person to clearly recognize the nature 
and severity of his or her illness. This is done on both an 
in-patient and outpatient basis. Alcoholism is a disease 
of denial; as members of Alcoholics Anonymous put it, it 
is “the only disease that keeps telling you that you do not 
have a disease.” Recall that often the alcoholic is made 
aware of his or her condition through what is called an 
intervention, a meeting with family and/or significant 
people who describe for the alcoholic the symptoms of 
alcoholism that they have witnessed and how these 
symptoms have affected them. This is important because 
alcoholics who are actively drinking are often not aware 
of what they do, nor do they remember later what they 
have done. (Interventions are sometimes done before the 
problem becomes serious enough to require detoxifica- 
tion from alcohol). Essential to recovery is the awareness 
of powerlessness over the disease, acceptance of having 
the disease, and abstinence from the substance that per- 
petuates the disease. 




There is no cure for alcoholism. Sessions led by 
peers, such as Alcoholics Anonymous (AA) meetings, 
are often part of in-patient hospital treatment. AA meet- 
ings, where recovering alcoholics meet regularly and 
provide support for each other’s recovery, are considered 
among the best methods of preventing a return to drink- 
ing (relapse). The AA program is a twelve-step program. 
Its steps involve recognizing the destructive power that 
alcohol has held over the alcoholic’s life, looking to a 
Higher Power for help in overcoming the problem, re- 
flecting on the ways in which the use of alcohol has hurt 
others, and if possible, making amends to those people. 
The final step involves carrying the message of hope and 
recovery to other sick and suffering alcoholics. The 
Serenity Prayer becomes an ally: “God grant me the 
strength to accept the things I cannot change, the 
courage to change the things I can change, and the wis- 
dom to know the difference.” 

The best programs incorporate the alcoholic’s fami- 
ly or loved ones into the therapy, because loved ones 
have undoubtedly been severely affected by the drinking. 
Many therapists believe that families, in an effort to deal 
with the alcoholic’s drinking problem, develop patterns 
of behavior that unwittingly support or “enable” the pa- 
tient’s drinking. This situation is referred to as co-depen- 
dency. The twelve-step programs of A1 Anon and Adult 
Children of Alcoholics are often very successful in help- 
ing the families or loved ones of alcoholics. 

There are also medications that may help an alco- 
holic avoid returning to drinking. These have been used 
with variable success. Disulfiram (Antabuse) is a drug 
which, when mixed with alcohol, causes a very unpleas- 
ant reaction that includes nausea and vomiting, diarrhea, 
and trembling. Naltrexone (a drug that blocks a narcotic 
high and may reduce the urge to drink) and acamprosate 
seem to be helpful in limiting the effects of a relapse. 
Naltrexone, found to produce liver damaging side ef- 
fects, may be a difficultly exercised option. None of 
these medications has been found to be helpful unless 
the patient is also willing to work very hard to change 
his or her behavior. 

Expected results 

As noted earlier, there is no cure for alcoholism. Re- 
covery from alcoholism is a lifelong process. In fact, 
people who have suffered from alcoholism are encour- 
aged to refer to themselves ever after as a recovering al- 
coholic, never a recovered alcoholic. Alcoholism can 
only be arrested — by abstaining from the drug, alcohol. 
The potential for relapse (returning to illness) is always 
there, and it must be acknowledged and respected. Sta- 
tistics suggest that among middle-class alcoholics in sta- 


ble financial and family situations who have undergone 
treatment, 60% or more can successfully stop drinking 
for at least a year, and many for a lifetime. 


Prevention is primarily related to education and 
early intervention. In a culture where alcohol is so in- 
grained, education about the dangers of this drug is vital- 
ly important, even as early as early childhood. Since al- 
cohol is the easiest and cheapest drug to obtain and the 
one most commonly used by teens, the first instance of 
intoxication (drunkenness) with alcohol usually occurs 
during the teenage years. It is particularly important that 
teenagers who are at high risk for alcoholism be made 
aware of this danger. Those at high risk include those 
with a family history of alcoholism, an early or frequent 
use of alcohol, a tendency to drink to drunkenness, alco- 
hol use that interferes with schoolwork, a poor family 
environment, or a history of domestic violence. Peers are 
often the best people to provide this education, and 
groups such as SADD (Students Against Drunk Driving, 
a Marlborough, Massachusetts-based organization), ap- 
pear very effective. Courts and schools sometimes pro- 
vide education through local substance abuse programs, 
as well. Setting a good example, developing and practic- 
ing communication skills with your children, and frank 
discussions about the consequences of drinking, are all 
encouraged to prevent alcoholism related problems. De- 
veloping alternative coping skills to life’s problems is 
also essential, as is encouraging a more distant perspec- 
tive on the pervasive advertising that deceptively pro- 
motes alcohol’s health reducing glamour. 



American Psychiatric Association. Diagnostic and Statistical 
Manual of Mental Disorders. 4th ed. Washington, DC: 
American Psychiatric Association, 1994. 

Diamond, Ivan. “Alcoholism and Alcohol Abuse.” Cecil Text- 
book of Medicine, edited by J. Claude Bennett and Fred 
Plum. Philadelphia: W.B. Saunders, 1996. 

Schuckit, Marc A. "Alcohol and Alcoholism.” In Harrison's 
Principles of Internal Medicine, edited by Anthony S. 
Fauci, et al. New York: McGraw-Hill, 1998. 


Aesoph. Lauri M. “Kick the Habit — Naturally: Quit Drinking 
or Smoking With Herbs, Acupuncture, and the Right 
Diet.” Vegetarian Times (March 1996): 100+. 

Bullock, M. L., P. D. Culliton, and R. T. Oleander. “Controlled 
Trial of Acupuncture for Severe Recidivist Alcoholism.” 
Lancet (June 1989): 1435-1439. 

Dorsman, Jerry. “Improving Alcoholism Treatment: an 
Overview.” Behavioral Health Management (January- 
February 1996): 26+. 



Blood-brain barrier — A membrane that lines the 
blood vessels in the brain, it prevents many dam- 
aging substances from reaching the brain. Certain 
small molecules are able to cross the barrier, in- 
cluding water, oxygen, carbon dioxide, and alco- 

Dependence — A state in which a person requires 
a steady amount of a particular drug in order to 
avoid experiencing symptoms of withdrawal. 

Detoxification — The phase of treatment during 
which a patient stops drinking and is monitored 
and cared for while he or she experiences with- 
drawal from alcohol. 

Relapse — A return to a disease state after recovery 
appeared to be occurring. In alcoholism, relapse 
refers to a patient beginning to drink alcohol 
again after a period of avoiding it. 

Tolerance — A phenomenon whereby a drug user 
becomes physically accustomed to a particular 
quantity of alcohol (or dosage of a drug), and re- 
quires ever-increasing quantities in order to obtain 
the same effects. 

Withdrawal — Those signs and symptoms experi- 
enced by a person who has become physically de- 
pendent on a drug, experienced upon decreasing 
the drug's dosage or discontinuing its use. 

Ianelli, Joseph. “When Alcoholism Hits Home.” American 
Journal of Nursing (July 1997): 68+. 

O'Brien, Charles P., and A. Thomas McLellan. “Addiction 
Medicine.” Journal of the American Medical Association 
(June 18, 1997): 1840+. 

“Spotting a Drinking Problem.” Consumer Reports on Health 
(September 1997): 106+. 


Al-Anon, Alanon Family Group, Inc. P.O. Box 862, Midtown 
Station, New York, NY 10018-0862. (800) 356-9996. 

National Alliance on Alcoholism and Drug Dependence, Inc. 
12 West 21st St., New York, NY 10010. (212) 206-6770. 

National Clearinghouse for Alcohol and Drug Information. 


Alcohol Abuse and Alcoholism. MedicineNet, Inc. 1996-2004. 
[cited May 28, 2004]. <>. 

Alcoholism. Mayo Foundation for Medical Education and Re- 
search. 1998-2004. Updated, July 3, 2002. [cited May 28, 
2004], <>. 


FAQs on Alcohol Abuse and Alcoholism. National Institute on 
Alcohol Abuse and Alcoholism (NIAAA). Updated, 
March 2003. [cited May 28, 2004]. <http://www.maaa.>. 

Katherine E. Nelson, N.D. 

Alexander technique 


The Alexander technique is a somatic method for 
improving physical and mental functioning. Excessive 
tension, which Frederick Alexander, the originator, rec- 
ognized as both physical and mental, restricts movement 
and creates pressure in the joints, the spine, the breathing 
mechanism, and other organs. The goal of the technique 
is to restore freedom and expression to the body and 
clear thinking to the mind. 


Frederick Matthias Alexander was born in 1869 in 
Tasmania, Australia. He became an actor and Shake- 
spearean reciter, and early in his career he began to suf- 
fer from strain on his vocal chords. He sought medical 
attention for chronic hoarseness, but after treatment with 
a recommended prescription and extensive periods of 
rest, his problem persisted. 

Alexander realized that his hoarseness began about 
an hour into a dramatic performance and reasoned that it 
was something he did in the process of reciting that 
caused him to lose his voice. Returning to his medical 
doctor, Alexander told him of his observation. When the 
doctor admitted that he didn’t know what Alexander was 
doing to injure his vocal chords, Alexander decided to 
try and find out for himself. 

Thus began a decade of self-observation and discov- 
ery. Using as many as three mirrors to observe himself in 
the act of reciting, normal speaking, and later standing, 
walking, and sitting, Alexander managed to improve his 
coordination and to overcome his vocal problems. One 
of his most startling discoveries was that in order to 
change the way he used his body he had to change the 
way he was thinking, redirecting his thoughts in such a 
way that he did not produce unnecessary tension when 
he attempted speech or movement. After making this dis- 
covery at the end of the nineteenth century, Alexander 
became a pioneer in body-mind medicine. 

At first, performers and dancers sought guidance 
from Alexander to overcome physical complaints and to 


Alexander technique 

Alexander technique 

ALEXANDER 1869-1955 

Frederick Matthias (F.M.) Alexander was born in 
Australia where he began a career as a young actor. 
While leading the theater life, he developed chronic 
laryngitis. While tragic for a stage career, his lingering 
ailment would lead to his discovery of the Alexander 
Technique, which would ultimately help people around 
the world rid their bodies of tension and stress. 

At the age of 1 9, Alexander became frustrated with 
a medical practitioner's inability to treat his hoarseness 
and was determined to find the cause of his malady. Al- 
though lacking any medical training, Alexander began 
to meticulously observe his manner of coordination 
while speaking and reciting with the use of strategically 
placed mirrors. After following this method of study for 
1 0 years, Alexander concluded that modern society was 
causing individuals to severely misuse the human sys- 
tem of locomotion, thus resulting in the dysfunction of 
other systems of the body. His experiments and tech- 
nique laid the groundwork in the early 1900s for good 
habits of coordination or the proper use of the neuro- 
muscular system. 

Alexander left Australia for London in 1904. The 
popularity of the Alexander Technique led him to work 
with intellectuals such as George Bernard Shaw and Al- 
dous Huxley. Alexander also taught extensively 
throughout the United States. 

As of 1 995, The Alexander Technique is taught in 
26 countries, and there are nine affiliated societies 
overseeing a profession of approximately 2,000 teach- 
ers of the technique. Alexander's technique continues to 
have a profound impact on the training of musicians, 
actors, and dancers from around the world. 

Beth A. Kapes 

improve the expression and spontaneity of their perfor- 
mances. Soon a great number of people sought help from 
his teaching for a variety of physical and mental disorders. 


Because the Alexander technique helps students im- 
prove overall functioning, both mental and physical, it 
offers a wide range of benefits. Nikolaas Tinbergen, in 
his 1973 Nobel lecture, hailed the “striking improve- 
ments in such diverse things as high blood pressure, 
breathing, depth of sleep, overall cheerfulness and men- 
tal alertness, resilience against outside pressures, and the 
refined skill of playing a musical instrument.” He went 


on to quote a list of other conditions helped by the 
Alexander technique: “rheumatism, including various 
forms of arthritis, then respiratory troubles, and even po- 
tentially lethal asthma; following in their wake, circula- 
tion defects, which may lead to high blood pressure and 
also to some dangerous heart conditions; gastrointestinal 
disorders of many types, various gynecological condi- 
tions, sexual failures, migraines and depressive states.” 

Literature in the 1980s and 1990s went on to include 
improvements in back pain, chronic pain, postural prob- 
lems, repetitive strain injury, benefits during pregnancy 
and childbirth, help in applying physical therapy and reha- 
bilitative exercises, improvements in strain caused by com- 
puter use, improvements in the posture and performance of 
school children, and improvements in vocal and dramatic 
performance among the benefits offered by the technique. 


The Alexander technique is primarily taught one-on- 
one in private lessons. Introductory workshops or work- 
shops for special applications of the technique (e.g., work- 
shops for musicians) are also common. Private lessons 
range from a half-hour to an hour in length, and are taught 
in a series. The number of lessons varies according to the 
severity of the student’s difficulties with coordination or to 
the extent of the student’s interest in pursuing the improve- 
ments made possible by continued study. The cost of 
lessons ranges from $40-80 per hour. Insurance coverage is 
not widely available, but discounts are available for partici- 
pants in some complementary care insurance plans. Pre-tax 
Flexible Spending Accounts for health care cover Alexan- 
der technique lessons if they are prescribed by a physician. 

In lessons teachers guide students through simple 
movements (while students are dressed in comfortable 
clothing) and use their hands to help students identify 
and stop destructive patterns of tension. Tensing arises 
from mental processes as well as physical, so discus- 
sions of personal reactions or behavior are likely to arise 
in the course of a lesson. 

The technique helps students move with ease and 
improved coordination. At the beginning of a movement 
(the lessons are a series of movements), most people pull 
back their heads, raise their shoulders toward their ears, 
over-arch their lower backs, tighten their legs, and other- 
wise produce excessive tension in their bodies. Alexan- 
der referred to this as misuse of the body. 

At any point in a movement, proper use can be es- 
tablished. If the neck muscles are not over-tensed, the 
head will carry slightly forward of the spine, simply be- 
cause it is heavier in the front. When the head is out of 
balance in the forward direction, it sets off a series of 
stretch reflexes in the extensor muscles of the back. It is 


skillful use of these reflexes, along with reflex activity in 
the feet and legs, the arms and hands, the breathing 
mechanism, and other parts of the body, that lessons in 
the technique aim to develop. 

Alexander found that optimal functioning of the 
body was very hard to maintain, even for the short period 
of time it took to complete a single movement. People, 
especially adults, have very strong tension habits associ- 
ated with movement. Chronic misuse of the muscles is 
common. It may be caused by slouching in front of tele- 
visions or video monitors, too much sitting or driving and 
too little walking, or by tension associated with past trau- 
mas and injuries. Stiffening the neck after a whiplash in- 
jury or favoring a broken or sprained leg long after it has 
healed are examples of habitual tension caused by injury. 

The first thing a teacher of the Alexander technique 
does is to increase a student’s sensory awareness of this 
excessive habitual tension, particularly that in the neck 
and spine. Next the student is taught to inhibit the ten- 
sion. If the student prepares to sit down, for example, he 
will tense his muscles in his habitual way. If he is asked 
to put aside the intention to sit and instead to free his 
neck and allow less constriction in his muscles, he can 
begin to change his tense habitual response to sitting. 

By leaving the head resting on the spine in its natural 
free balance, by keeping eyes open and focused, not held 
in a tense stare, by allowing the shoulders to release, the 
knees to unlock and the back to lengthen and widen, a 
student greatly reduces strain. In Alexander lessons stu- 
dents learn to direct themselves this way in activity and 
become skilled in fluid, coordinated movement. 


Side effects 

The focus of the Alexander technique is educational. 
Teachers use their hands simply to gently guide students 
in movement. Therefore, both contraindications and po- 
tential physiological side effects are kept to a minimum. 
No forceful treatment of soft tissue or bony structure is 
attempted, so damage to tissues, even in the case of er- 
rors in teaching, is unlikely. 

As students’ sensory awareness develops in the course 
of Alexander lessons, they become more acutely aware of 
chronic tension patterns. As students learn to release exces- 
sive tension in their muscles and to sustain this release in 
daily activity, they may experience tightness or soreness in 
the connective tissue. This is caused by the connective tis- 
sue adapting to the lengthened and released muscles and 
the expanded range of movement in the joints. 

Occasionally students may get light-headed during a 
lesson as contracted muscles release and effect the circu- 
latory or respiratory functioning. 


Forceful contraction of muscles and rigid postures 
often indicate suppression of emotion. As muscles re- 
lease during or after an Alexander lesson, students may 
experience strong surges of emotion or sudden changes 
in mood. In some cases, somatic memories surface, 
bringing to consciousness past injury or trauma. This can 
cause extreme anxiety, and referrals may be made by the 
teacher for counseling. 

Research & general acceptance 

Alexander became well known among the intellectual, 
artistic, and medical communities in London, England dur- 
ing the first half of the twentieth century. Among Alexan- 
der’s supporters were John Dewey, Aldous Huxley, Bernard 
Shaw, and renowned scientists Raymond Dart, G.E. 
Coghill, Charles Sherrington, and Nikolaas Tinbergen. 

Researchers continue to study the effects and appli- 
cations of the technique in the fields of education, pre- 
ventive medicine, and rehabilitation. The Alexander 
technique has proven an effective treatment for reducing 
stress, for improving posture and performance in school- 
children, for relieving chronic pain, and for improving 
psychological functioning. The technique has been 
found to be as effective as beta-blocker medications in 
controlling stress responses in professional musicians, to 
enhance respiratory function in normal adults, and to 
mediate the effects of scoliosis in adolescents and adults. 

Training & certification 

Before his death in 1955, F.M. Alexander formed 
the Society for Teachers of the Alexander Technique 
(STAT) in London, England. The Society is responsible 
for upholding the standards for teachers of the technique. 
In the late 1980s, due to rapid growth of the Alexander 
teaching profession, STAT authorized replication of its 
certification body in many countries worldwide. 

The American Society for the Alexander Technique 
(AmSAT) oversees the profession in the United States. 
Teachers are board certified according STAT standards. 
They must receive 1600 hours of training over three 
years at an AmSAT approved training program. Alexan- 
der Technique International (ATI), a second organization 
for teachers in the United States, has varied standards for 
teacher certification. 



Caplan, Deborah. Back Trouble - A new approach to prevention 

and recovery based on the Alexander Technique. Triad 

Communications: 1987. 

Dirnon, Theodore. THE UNDIVIDED SELF: Alexander Tech- 
nique and the Control of Stress. North Atlantic Books: 1999. 


Alexander technique 



Direction — Bringing about the free balance of the 
head on the spine and the resulting release of the 
erector muscles of the back and legs which estab- 
lish improved coordination. 

Habit — Referring to the particular set of physical 
and mental tensions present in any individual. 

Inhibition — Referring to the moment in an Alex- 
ander lesson when the student refrains from be- 
ginning a movement in order to avoid tensing of 
the muscles. 

Sensory awareness — Bringing attention to the sen- 
sations of tension and/or release in the muscles. 

Jones, Frank Pierce. Freedom To Change - The Development and 
Science of the Alexander Technique. Mouritz: 1997, import- 
ed (First published 1976 as Body Awareness in Action.) 


Stern, Judith C. “The Alexander Technique:An Approach to 
Pain Control !’ Lifeline (Summer 1992). 

Tinbergen, Nikolaas. “Ethology and Stress Diseases.” England 
Science 185 (1974):20-27. 


American Society for the Alexander Technique, 401 East Market 
Street (P.O. Box 835) Charlottesville, VA 22902 USA. (800) 
473-0620; or (804) 295-2840. Fax: 804-295-3947. alexan- <> 

Alexander Technique International, 1692 Massachusetts Ave. ,3rd 
Floor, Cambridge, MA 02138 USA. (888) 321-0856. Fax: 
617-497-2615. <> 


Alexander Technique Resource Guide, (includes list of teach- 
ers) AmS AT Books, (800) 473-0620 or (804) 295-2840. 

Nielsen, Michael. “A Study of Stress Amongst Professional 
Musicians.” STAT Books London, 1994. 

Reiser, Samuel. “Stress Reduction and Optimal Psychological 
Functioning." Lecture given at Sixth International Mon- 
treaus Congress on Stress, 1994. 

Sandra Bain Cushman 



Alfalfa is the plant Medicago sativa. There are many 
subspecies. It is a perennial plant growing up to 30 in 


(0.75 m) in height in a wide range of soil condition. Its 
small flowers range from yellow to purple. Alfalfa is 
probably native to the area around the Mediterranean 
Sea, but it is extensively cultivated as fodder for live- 
stock in all temperate climates. 

Alfalfa is a member of the legume family. It has the 
ability to make nutrients available to other plants both 
through its very long, deep (6-16 ft [2-5 m]) root sys- 
tem, and because it has a hosts beneficial nitrogen-fixing 
bacteria. For these reasons it is often grown as a soil im- 
prover or “green manure.” The medicinal parts of alfalfa 
are the whole plant and the seeds. It is used both in West- 
ern and traditional Chinese medicine. In Chinese it is 
called zi mu. Other names for alfalfa include buffalo 
grass, buffalo herb, Chilean clover, purple medick, pur- 
ple medicle, and lucerne. 

General use 

Alfalfa has been used for thousands of years in many 
parts of the world, as a source of food for people and live- 
stock and as a medicinal herb. It is probably more useful 
as a source of easily accessible nutrients than as a medici- 
nal herb. Alfalfa is an excellent source of most vitamins, 
including vitamins A, D, E, and K. Vitamin K is critical 
in blood clotting, so alfalfa may have some use in im- 
proving clotting. It also contains trace minerals such as 
calcium, magnesium, iron, phosphorous, and potassi- 
um. Alfalfa is also higher in protein than many other 
plant foods. This abundance of nutrients has made alfalfa 
a popular tonic for convalescents when brewed into tea. 

In addition to using the seeds and leaves as food, al- 
falfa has a long history of folk use in Europe as a diuretic 
or “water pill.” It is also said that alfalfa can lower cho- 
lesterol. Alfalfa is used as to treat arthritis, diabetes, di- 
gestive problems, weight loss, ulcers, kidney and bladder 
problems, prostate conditions, asthma, and hay fever. 
Alfalfa is also said to be estrogenic (estrogen-like). 

Alfalfa is not native to the United States and did not 
arrive until around 1850. However, once introduced, it 
spread rapidly and was adapted by Native Americans as 
a food source for both humans and animals. The seeds 
were often ground and used as a flour to make mush. 
The leaves were eaten as vegetable. The main medical 
use for alfalfa in the United States was as a nutritious tea 
or tonic. 

In China, alfalfa, or zi mu, and a closely related 
species tooth-bur clover, Medicago hispida or nan mu xu 
have been used since the sixth century. Alfalfa is a minor 
herb in traditional Chinese medicine. It is considered to 
be bitter in taste and have a neutral nature. Traditional 
Chinese healers use alfalfa leaves to cleanse the digestive 
system and to rid the bladder of stones. 


The root of alfalfa is used in Chinese medicine to re- 
duce fever, improve urine flow, and treat jaundice, kid- 
ney stones, and night blindness. Contrary to the West- 
ern belief that alfalfa will aid in weight gain, Chinese 
herbalists believe that extended use of alfalfa will cause 
weight loss. 

Alfalfa contains hundreds of biologically active 
compounds, making it difficult to analyze and to ascribe 
healing properties to any particular component. In addi- 
tion to the nutrients mentioned above, alfalfa contains 
two to three percent saponin glycosides. In test tube and 
animal studies, saponin glycosides have been shown to 
lower cholesterol, but there is no evidence that this cho- 
lesterol-lowering effect occurs in humans. In addition, 
saponin glycosides are known to cause red blood cells to 
break open (hemolysis) and to interfere with the body’s 
utilization of vitamin E. 

No modern scientific evidence exists that alfalfa in- 
creases urine output, effectively treats diabetes, aids kid- 
ney or bladder disorders, improves arthritis, reduces ul- 
cers, or treats respiratory problems. Similarly, there is no 
scientific evidence that alfalfa either stimulates the ap- 
petite or promotes weight loss. There is no evidence that 
alfalfa has any estrogenic effect on menstruation. There 


is evidence, however, that although for most people alfalfa 
is harmless, for some people it can be dangerous to use. 


Although alfalfa is available as fresh or dried leaf, it 
is most often taken as a capsule of powdered alfalfa or as 
a tablet. When dried leaves are used, steeping one ounce 
of dried leaves in one pint of water for up to 20 minutes 
makes a tea. Two cups of this tea are drunk daily. 

In traditional Chinese medicine, juice squeezed 
from fresh alfalfa is used to treat kidney and bladder 
stones. To treat fluid retention, alfalfa leaves are added to 
a soup along with bean curd and lard. 


Although alfalfa is harmless to most people when 
taken in the recommended quantities, people with the au- 
toimmune disease systemic lupus erythematosus (SLE) 
should not take any form of alfalfa. In a well-document- 
ed study, people with latent SLE reactivated their symp- 
toms by using alfalfa. In another study, monkeys fed al- 
falfa sprouts and seeds developed new cases of SLE. 





Diuretic — Any substance that increases the pro- 
duction of urine. 

Estrogenic — Having properties that mimic the 
functions of the female hormone, estrogen. 

People with other autoimmune diseases should stay 
away from alfalfa as a precautionary measure. In addi- 
tion, some allergic reactions have been reported to alfalfa 
tablets contaminated with other substances. 

Side effects 

No side effects are reported in healthy people using 
alfalfa in the recommended doses. 


There are no studies of the interactions of alfalfa and 
traditional pharmaceuticals. 



Chevallier. Andrew. Encyclopedia of Medicinal Plants. Lon- 
don: Dorling Kindersley, 1996. 

Peirce, Andrea. The American Pharmaceutical Association 
Practical Grade to Natural Medicines. New York: William 
Morrow and Company, 1999. 

PDR for Herbal Medicines. Montvale, New Jersey: Medical 
Economics Company, 1999. 

Tish Davidson 



Alisma, a member of the plant family Alismataceae, 
is a herb commonly used in traditional Chinese medi- 
cine (TCM). The medicinal part of the plant is the dried 
root of Alisma plantago-aquatica . Alisma is also called 
mad-dog weed, water plantain, American water plan- 
tain, or northern water plantain. It belongs to a different 
species from the edible plantain or cooking banana of the 
Caribbean or the plantain that produces psyllium seed. 
The Chinese name for alisma is ze xie. 

Alisma is a perennial plant that grows aggressively 
in shallow water and boggy spots in parts of Europe, 


North America, and northern China. Its leaves take dif- 
ferent shapes depending on whether the leaves grow 
above or in the water. The plant rarely reaches a height 
of more than 30 in (0.9 m). There are several subspecies 
of Alisma plantago found throughout the world, but their 
medicinal uses are the same. 

General use 

Alisma has been used for centuries in China. It is 
also used today in North America and Europe. In the cat- 
egories used by traditional Chinese medicine, which 
classifies herbs according to energy level (hot, warm, 
cool, or cold) as well as taste, alisma is said to have a 
cold nature and a sweet, bland taste. It is used primarily 
to treat conditions of damp heat associated with the kid- 
ney, bladder, and urinary tract. 

Alisma is a diuretic and is used to rid the body of 
excess water. It has mild and safe tonic qualities that es- 
pecially affect the kidney and bladder. It is often com- 
bined with other herbs in general tonic formulas. It is 
used to treat kidney stones, pelvic infections, nephritis, 
and other urinary tract infections, as well as yellowish 
discharges from the vagina. Alisma is also believed to 
have an antibacterial action that helps control infection. 
In China, alisma is also used to help rid the body of 
phlegm, to reduce feelings of abdominal bloating, and to 
treat diabetes. The herb is also widely used in Japan. 

Outside of China, alisma leaves are sometimes used 
medicinally. They can be applied externally to bruises 
and swellings, or taken internally to treat kidney and uri- 
nary tract inflammations. The roots are also used for kid- 
ney and urinary tract disorders, as well as to lower blood 
pressure and to treat severe diarrhea. A minor homeo- 
pathic remedy can also be made from the root. 

Modern scientific research shows that alisma does 
act as a mild diuretic. In several studies done in Japan, 
alisma extracts were shown to reduce artificially induced 
swelling in the paws of rats. Studies using human sub- 
jects have not been done, but test tube and animal studies 
do seem to indicate that there is a scientific basis for 
some of the traditional uses of alisma. There is also some 
indication that alisma does have a mild antibacterial ef- 
fect, but again, evidence in humans is anecdotal and by 
observation rather than by controlled trials. 


Alisma roots are harvested before the plant blooms 
and is dried for future use. Fresh root is toxic. Heating or 
drying deactivates the poisonous compounds in the root. 
If the leaves are used, they must be boiled for a long time 
before using. Fresh leaves are also poisonous. 



Diuretic — A medication or substance that increas- 
es the production of urine. 

Alisma is an ingredient in many common Chinese 
preparations to improve kidney balance and general 
health. These include rehmannia eight and rehmannia six 
combination, lycium chrysanthemum and rehmannia 
combination, rehmannia and schizandra, rehmannia and 
cornus, rehmannia and magnetitum formula, immortal 
long life pill, gentiana, and hoeln five. An extract of al- 
isma root is commercially available. Some herbalists in- 
dicate that a large dose is necessary for alisma to be 
completely effective when treating infections, or that it 
should be combined with other anti-infective herbs. 


Fresh alisma roots and leaves are poisonous. Dried 
roots or cooked leaves are safe, even in fairly large doses. 
However, the kidney infections that alisma is used to 
treat can be serious. Anyone who suspects that they have 
a kidney infection should see a medical practitioner. 

Side effects 

Some Chinese herbalists indicate that long-term use 
of alisma can irritate the intestines. 


In China and Japan, alisma is often taken together 
with antibiotics for kidney infections without any nega- 
tive interactions. Since alisma is primarily an Asian herb, 
there is no body of information on how it might interact 
with most Western pharmaceuticals. 



Molony, David. Complete Guide to Chinese Herbal Medicine. 

New York: Berkeley Books, 1998. 

PDR for Herbal Medicines. Montvale, New Jersey: Medical 
Economics Company, 1999. 

Teegaurden, Ron. The Ancient Wisdom of the Chinese Tonic 
Herbs. New York: Warner Books, 1998. 


American Association of Oriental Medicine (AAOM). 433 
Front Street, Catasauqua, PA 18032. (610) 266-2433. 

Tish Davidson 


Allergic rhinitis see Hay fever 



Allergies are abnormal reactions of the immune sys- 
tem that occur in response to otherwise harmless sub- 


Allergies are among the most common medical dis- 
orders. It is estimated that 60 million Americans, or more 
than one in every five people, suffer from some form of 
allergy, with similar proportions throughout much of the 
rest of the world. Allergy is the single largest reason for 
school absence and is a major source of lost productivity 
in the workplace. 

An allergy is a type of immune reaction. Normally, 
the immune system responds to foreign bodies, like 
pollen or bacteria, by producing specific proteins called 
antibodies that are capable of binding to identifying mol- 
ecules (antigens) on the foreign body. This reaction be- 
tween antibody and antigen sets off a series of reactions 
designed to protect the body from infection. Harmless, 
everyday substances trigger this same series of reactions. 
This is the condition known as allergy, and the offending 
substance is called an allergen. 

Allergens enter the body through four main routes: 
the airways, the skin, the gastrointestinal tract, and the 
circulatory system. 

• Airborne allergens cause the sneezing, runny nose, and 
itchy, bloodshot eyes of hay fever (allergic rhinitis). 
Airborne allergens can also affect the lining of the 
lungs, causing asthma, or the conjunctiva of the eyes, 
causing conjunctivitis (pink eye). 

• Allergens in food can cause itching and swelling of the 
lips and throat, cramps, and diarrhea. When absorbed 
into the bloodstream, they may cause hives or more se- 
vere reactions involving recurrent, non-inflammatory 
swelling of the skin, mucous membranes, organs, and 
brain (angioedema). Some food allergens may cause 
anaphylaxis, a potentially life-threatening condition 
marked by tissue swelling, airway constriction, and 
drop in blood pressure. 

• In contact with the skin, allergens can cause reddening, 
itching, and blistering, called contact dermatitis. Skin 
reactions can also occur from allergens introduced 
through the airways or gastrointestinal tract. This type 
of reaction is known as atopic dermatitis. 



Allergic rhinitis is commonly triggered by 
exposure to household dust, animal fur, 
or pollen. The foreign substance that 
triggers an allergic reaction is called 
an allergen. 

The presence of an allergen causes the 
body's lymphocytes to begin producing 
IgE antibodies. The lymphocytes of an 
allergy sufferer produce an unusually 
large amount of IgE. 

Pollen grains 


In a future exposure to the same substance, 
the antibodies on the mast cells bind to the 
allergens, and the cells release their histamine. 


Histamine travels to receptor sites in the nasal 
passages. When histamine molecules enter the 
sites they trigger dilation of the blood vessels, 
swelling, irritation, and increased production 
of mucus. 





Antihistamine drugs block histamine molecules 
from entering receptor sites, thus preventing or 
reducing swelling, congestion and irritation. 

The allergic response. (Illustration by Hans & Cassidy. The Gale Group.) 



• Injection of allergens, from insect bites and stings or 
drug administration, can introduce allergens directly into 
the circulation, where they may cause system-wide re- 
sponses (including anaphylaxis), as well as the local re- 
sponses like swelling and irritation at the injection site. 

People with allergies are not equally sensitive to all 
allergens. Allergies may get worse over time. For exam- 
ple, childhood ragweed allergy may progress to year- 
round dust and pollen allergy. On the other hand, a per- 
son may lose allergic sensitivity. Infant or childhood 
atopic dermatitis disappears in almost all people. More 
commonly, what seems to be loss of sensitivity is instead 
a reduced exposure to allergens or an increased tolerance 
for the same level of symptoms. 

Causes & symptoms 


Immunologists separate allergic reactions into two 
main types: immediate hypersensitivity reactions, which 
are mainly mast cell-mediated and occur within minutes 
of contact with allergen, and delayed hypersensitivity re- 
actions, mediated by T cells (a type of white blood cells) 
and occurring hours to days after exposure. 

In the upper airways and eyes, immediate hypersen- 
sitivity reactions cause the runny nose and itchy, blood- 
shot eyes typical of allergic rhinitis. In the gastrointesti- 
nal tract, these reactions lead to swelling and irritation of 
the intestinal lining, which causes the cramping and diar- 
rhea typical of food allergy. Allergens that enter the cir- 
culation may cause hives, angioedema, anaphylaxis, or 
atopic dermatitis. 

Allergens on the skin usually cause delayed hyper- 
sensitivity reaction. Roving T cells contact the allergen, 
setting in motion a more prolonged immune response. 
This type of allergic response may develop over several 
days following contact with the allergen, and symptoms 
may persist for a week or more. 

THE ROLE OF INHERITANCE. While allergy to specif- 
ic allergens is not inherited, the likelihood of developing 
some type of allergy seems to be, at least for many peo- 
ple. If neither parent has allergies, the chances of a child 
developing allergy is approximately 10-20%; if one par- 
ent has allergies, it is 30-50%; and if both have allergies, 
it is 40-75%. 

COMMON ALLERGENS. The most common airborne 
allergens are the following: 

• plant pollens 

• animal fur and dander 

• body parts from house mites (microscopic creatures 
found in all houses) 

• house dust > 

• mold spores 


• cigarette smoke 

• solvents 

• cleaners 

Common food allergens include the following: 

• nuts, especially peanuts, walnuts, and Brazil nuts 

• fish, mollusks, and shellfish 

• eggs 

• wheat 

• milk 

• food additives and preservatives 

Common causes of contact dermatitis include the 

• poison ivy, oak, and sumac 

• nickel or nickel alloys 

• latex 

Insects and other arthropods whose bites or stings 
typically cause allergy include the following: 

• bees, wasps, and hornets 

• mosquitoes 

• fleas 

• scabies 


Symptoms depend on the specific type of allergic re- 
action. Allergic rhinitis is characterized by an itchy, runny 
nose often with a scratchy or irritated throat due to post- 
nasal drip. Inflammation of the thin membrane covering 
the eye (allergic conjunctivitis) causes redness, irritation 
and increased tearing in the eyes. Asthma causes wheez- 
ing, coughing, and shortness of breath. Symptoms of 
food allergies depend on the tissues most sensitive to the 
allergen and whether it is spread systemically by the cir- 
culatory system. Gastrointestinal symptoms may include 
swelling and tingling in the lips, tongue, palate or throat; 
nausea; cramping; diarrhea; and gas. Contact dermatitis 
is marked by reddened, itchy, weepy skin blisters. 

Whole body or systemic reactions may occur from 
any type of allergen, but are more common following in- 
gestion or injection of an allergen. Skin reactions include 
the raised, reddened, and itchy patches called hives. A 
deeper and more extensive skin reaction, involving more 
extensive fluid collection, is called angioedema. Ana- 
phylaxis, another reaction, is marked by difficulty 
breathing, blood pressure drop, widespread tissue 




swelling, heart rhythm abnormalities, lightheadedness, 
and in some cases, loss of consciousness. 


Allergies can often be diagnosed by a careful med- 
ical history, matching the onset of symptoms to the ex- 
posure to possible allergens. Allergy tests can be used to 
identify potential allergens. These tests usually begin 
with prick tests or patch tests, which expose the skin to 
small amounts of allergen to observe the response. Reac- 
tion will occur on the skin even if the allergen is normal- 
ly encountered in food or in the airways. RAST testing is 
a blood test that measures the level of reactive antibodies 
in the blood. Provocation tests, most commonly done 
with airborne allergens, present the allergen directly 
through the route normally involved. Food allergen 
provocation tests require abstinence from the suspect al- 
lergen for two weeks or more, followed by ingestion of a 
measured amount. Provocation tests are not used if ana- 
phylaxis is a concern due to the patient’s medical history. 


Allergic rhinitis 

The following can help to relieve the symptoms of 
airborne allergies: 

• Stinging nettle ( Urtica dioica ) has antihistamine and 
anti-inflammatory properties. The common dose is 300 
mg four times daily. 

• Grape (Vitis vinifera ) seed extract has antihistamine 
and anti-inflammatory properties. The usual dose is 50 
mg three times daily. 

• Ephedra ( Ephedra sinicia), also called ma huang, has 
anti-inflammatory activity and is proven effective in treat- 
ing allergies. Taken as a tea thrice daily or 12.5-25 mg in 
capsule form. Ephedra should not be used for prolonged 
periods of time, as it can raise blood pressure, cause rapid 
heartbeat, and interfere with adrenal gland function. 

• Licorice ( Glycyrrhiza glabra ) has cortisone-like activi- 
ty which is anti-inflammatory, stimulates the adrenals, 
and relieves allergy symptoms. Can be taken as a tea or 
100-300 mg in capsule form. Long term use can result 
in sodium retention or potassium loss. 

• Chinese skullcap ( Scutellaria baicalensis ) has bron- 
chodilator activity, is an anti-inflammatory, and pre- 
vents allergic reactions. It is taken in combination with 
other herbs. 

• Ginkgo ( Ginkgo biloba) seeds are used in Chinese 
medicine for wheezing and coughing. 

• Echinacea ( Echinacea species) may have anti- inflam- 
matory activity and boost the immune system. 


• Khellin ( Ammi visnaga ) has bronchodilator activity. 

• Cramp ( Viburnum opulus) bark has bronchodilator ac- 

• Traditional Chinese medicine treats allergic rhinitis 
with various species. Patent combination medicines 
are: Bu Zhong Yi Qi Wan (Tonify the Middle and Aug- 
ment the Qi) and Yu Ping Feng San (Jade Windscreen) 
are used for preventing allergies, and Bi Yan Pian 
(Rhinitis Infusion) is often prescribed for syptoms af- 
fecting the nose. 

• The homeopathic remedies Rhus toxicodendron, Apis 
mellifica, and Nux vomica have decongestant activities. 
They are taken internally. 

• Vitamin C has antihistamine and decongestant activities. 

• Vitamins A and E are antioxidants and help to pro- 
mote normal functioning of the immune system. 

• Coenzyme Q 10 may help to promote normal function- 
ing of the immune system. 

• Zinc may boost the immune system. 

• N-acetylcysteine may have decongestant activity. 

• Acupuncture has been shown to be as effective as anti- 
histamine drugs in treating allergic rhinitis. It is also 
used to help prevent allergic reactions by strengthening 
the immune system. 

Skin reactions 

A variety of herbal remedies, either applied topical- 
ly or taken internally, can assist in the treatment of con- 
tact dermatitis. A poultice made of jewelweed ( Impatiens 
species) or chickweed (Stellaria media) can soothe the 
skin. A cream or wash containing calendula (Calendula 
officinalis), a natural antiseptic and anti-inflammatory 
agent, can help heal the rash. Chinese herbal remedies 
have been effective in treating atopic dermatitis. The fol- 
lowing are homeopathic remedies to be taken internally: 

• Apis ( Apis mellifica) for hives that feel better with cold 
application and bee stings 

• Poison ivy (Rhus toxicodendron) for hives that feel bet- 
ter with hot applications and for poison ivy, oak, or 
sumac rashes 

• Stinging nettle (Urtica mens) for hives 

• Marsh tea (Ledum) for itching insect bites 

• Croton (Croton tiglium) oil for poison ivy, oak, or 
sumac rashes 

Food allergies 

Food allergy may be managed by oral desensitiza- 
tion. Children with allergy to milk, eggs, fish, or apples 


who followed an oral desensitization procedure devel- 
oped resistance to the allergenic food. Oral desensitiza- 
tion exposes the patient to allergens in controlled, but in- 
creasing, doses. Control subjects, who had avoided the 
allergenic food during the study, were still sensitive. 

Allopathic treatment 

A large number of prescription and over-the-counter 
drugs are available for treatment of immediate hypersen- 
sitivity reactions. Most of these drugs work by decreas- 
ing the ability of histamine to provoke symptoms. Other 
drugs counteract the effects of histamine by stimulating 
other systems or reducing immune responses in general. 

ANTIHISTAMINES. Antihistamines block the hista- 
mine receptors on nasal tissue, decreasing the effect of 
histamine released by mast cells. They may be used after 
symptoms appear, though they seem to prove more ef- 
fective when used preventively. A wide variety of anti- 
histamines are available. 

DECONGESTANTS. Decongestants constrict blood 
vessels to counteract the effects of histamine. Nasal 
sprays and oral systemic preparations are available. De- 
congestants are stimulants and may cause increased 
heart rate and blood pressure, headaches, and agitation. 
Use of nasal sprays for longer than several days can 
cause loss of effectiveness and rebound congestion, in 
which nasal passages become more severely swollen 
than before treatment. 

TOPICAL CORTICOSTEROIDS. Topical corticosteroids 
reduce mucous membrane and skin inflammation and are 
available by prescription. Allergies tend to become worse 
as the season progresses and topical corticosteroids are 
especially effective at reducing this seasonal sensitiza- 
tion. As a result, they are best started before allergy sea- 
son begins. A 2001 study revealed that steroid nasal 
sprays work better for seasonal allergies on an as-needed 
basis than do antihistamines. Side effects are usually 
mild, but may include headaches, nosebleeds, and un- 
pleasant taste sensations. 

MAST CELL STABILIZERS. Cromolyn sodium prevents 
the release of mast cell granules, thereby preventing the 
release of histamine and other chemicals contained in 
them. Cromolyn sodium is available as a nasal spray and 
aerosol (a suspension of particles in gas). 

BRONCHODILATORS. Because allergic reactions in- 
volving the lungs cause the airways or bronchial tubes to 
narrow, bronchodilators, which cause the smooth muscle 
lining the airways to open, can be very effective. Bron- 
chodilators include adrenaline, albuterol, and theo- 
phylline. Other drugs, including steroids, are used to pre- 
vent and control asthma attacks. 


Immunotherapy > 


Immunotherapy, also known as desensitization or al- era 
lergy shots, alters the balance of antibody types in the $ 
body. Injections involve gradually increasing amounts of 
allergen, over several weeks or months, with periodic 
boosters. Full benefits may take up to several years to 
achieve and are not seen at all in about one in five pa- 
tients. Individuals receiving all shots will be monitored 
closely following each shot because of the small risk of 
anaphylaxis, a condition that can result in difficulty 
breathing and a sharp drop in blood pressure. 

Possible future treatments 

In late 2001, a reports stated that a monoclonal anti- 
body called omalizumab might be effective in treating 
seasonal allergies and preventing related asthma. By 
blocking immunoglobulin E (IgE), an antibody that is 
found in excessive amounts in those with hay fever, the 
drug treats hay fever and helps prevent related asthma. 

Trials on the drug continue, and other immune-based 
medicines will likely accompany its ultimate release. 

Treatment of contact dermatitis 

Calamine lotion applied to affected skin can reduce ir- 
ritation somewhat. Topical corticosteroid creams are more 
effective, though overuse may lead to dry and scaly skin. 

Treatment of anaphylaxis 

The emergency condition of anaphylaxis is treated 
with injection of adrenaline, also known as epinephrine. 
People who are prone to anaphylaxis because of food or 
insect allergies often carry an “Epi-pen” containing 
adrenaline in a hypodermic needle. Prompt injection can 
prevent a more serious reaction from developing. 

Expected results 

Allergies can improve over time, although they 
often worsen. While anaphylaxis and severe asthma are 
life-threatening, other allergic reactions are not. Learn- 
ing to recognize and avoid allergy-provoking situations 
allows most people with allergies to lead normal lives. 


By determining which allergens are causing the reac- 
tions, most people can learn to avoid allergic reactions 
from food, drugs, and contact allergens. Airborne aller- 
gens are more difficult to avoid, although keeping dust 
and animal dander from collecting in the house may limit 
exposure. Vitamin C may prevent allergy symptoms. Cro- 
molyn sodium can be used for allergy prevention. 


Allium cepa 


Allergen — A substance that provokes an allergic 

Allergic rhinitis — Inflammation of the mucous 
membranes of the nose and eyes in response to an 

Anaphylaxis — Increased sensitivity caused by pre- 
vious exposure to an allergen that can result in 
blood vessel dilation and smooth muscle contrac- 
tion. Anaphylaxis can result in sharp blood pres- 
sure drops and difficulty breathing. 

Angioedema — Severe non-inflammatory swelling 
of the skin, organs, and brain that can also be ac- 
companied by fever and muscle pain. 

Antibody — A specific protein produced by the im- 
mune system in response to a specific foreign par- 
ticle called an antigen. 

Antigen — A foreign particle to which the body re- 
acts by making antibodies. 

Asthma — A lung condition in which the airways 
become narrow due to smooth muscle contraction, 
causing wheezing, coughing, and shortness of 

Atopic dermatitis — Infection of the skin as a result 
of exposure to airborne or food allergens. 

Conjunctivitis — Inflammation of the thin lining of 
the eye called the conjunctiva. 

Contact dermatitis — Inflammation of the skin as a 
result of contact with a substance. 

Histamine — A chemical released by mast cells that 
activates pain receptors and causes cells to be- 
come leaky. 

Mast cells — A type of immune system cell that is 
found in the lining of the nasal passages and eye- 
lids and participates in the allergic response by re- 
leasing histamine. 

T cells — White blood cells that stimulate cells to 
create and release antibodies. 



Lawlor G.J., Jr, T.J. Fischer, and D.C. Adelman. Manual of Al- 
lergy and Immunology. Boston: Little, Brown and Co., 

Weil. A. Natural Health, Natural Medicine: A Comprehensive 
Manual for Wellness and Self-Care. Boston: Houghton 
Mifflin, 1995. 

Ying, Zhou Zhong and Jin Hui De. “Common Diseases of 
Otorhinolaryngology and Stomatology.’" In Clinical Man- 
ual of Chinese Herbal Medicine and Acupuncture. New 
York: Churchill Livingston, 1997. 


Harder, Patty A. “Homeopathic First-Aid for Allergic Reac- 
tions.” Better Nutrition. 60 (June 1998): 42. 

Patriarca, G., D. Schiavino, E. Nucera, G. Schinco, A. Milani, 
and G.B. Gasbarrini. “Food Allergy in Children: Results 
of a Standardized Protocol for Oral Desensitization." He- 
pato-Gastroenterology. 45 (1998): 52-58. 

Plaut, Marshall. “Immune-Based, Tageted Therapy for Allergic 
Diseases.” JAMA. The Journal of the American Medical 
Association. (December 19, 2001): 3005. 

Siegel-Maier, Karyn. “Nettlesome Allergies! Natural Alterna- 
tives to Treat Seasonal Sneezing.” Mother Earth News. 
(September 1998): 24+ . 

“Steroid Nasal Spray Better for Season Allergies than Antihista- 
mines.” Immunotherapy Weekly (December 12, 2001): 12. 


Belinda Rowland 
Teresa Norris 

Allergy elimination diet see Elimination diet 

Allium cepa 


Allium cepa is the common onion. Although it is 
usually thought of as a vegetable, A. cepa also has a long 
history of medicinal use. 

Onions are perennials that are cultivated for food 
worldwide. There are many varieties. Most onion bulbs 
are white, yellow, or red. The green stems and leaves are 
hollow and can reach 3 ft ( 1 m) in height. The plants bear 
small flowers that are usually white or purple. The fleshy 
bulb that grows below the ground is used medicinally as 
well as for food. Onions are members of the lily family. 

General use 

Onion has been used as a food source for almost as long 
as humans have been keeping written records. Their useful- 
ness has been discovered independently by many cultures on 
several continents. Onions are mentioned in ancient Egypt- 


Onion plant. (© PlantaPhile, Germany. Reproduced by permission.) 

ian writings and were known in ancient Greece. In medieval 
Europe, they were used unsuccessfully to ward off plague. 

In North America, Native Americans used onion to 
treat insect stings and relieve colds. It is also used in tra- 
ditional Chinese medicine. Homeopaths make a tinc- 
ture of onion to treat a variety of conditions including 
cold, cough, diarrhea, facial paralysis, hay fever, her- 
nia, laryngitis, pneumonia, and trauma. 

Over the centuries, onion has been used for healing 
both internally and externally. Internally, onion has been 
recommended to treat colds, cough, bronchitis, whoop- 
ing cough, asthma, and other respiratory problems. It is 
believed to help loosen congestion in the lungs and ex- 
pand the airways. 

Onion is also used internally to relieve excess gas and 
calm an upset stomach. A mixture of me (Ruta graveolens) 
and onion is used to rid the digestive system of parasites. 
Onion is also thought to stimulate the appetite. 

Onion is believed to have a positive effect on the cir- 
culatory system. It has been used as a diuretic to reduce 
swelling. It is also thought to help reduce arteriosclerosis 
by lowering blood cholesterol levels and preventing the 


formation of blood clots. Onion has been used to treat 
diabetes and is reputed to lower blood sugar levels. 

Externally, fresh onion juice is used to prevent bac- 
terial and fungal infections. It can be applied to wounds 
and stings on the skin, used to remove warts, used to 
stimulate hair growth, and even used to reduce unwanted 
skin blemishes. Warm onion juice dropped in the ear is 
said to help relieve earache. Baked onion is used to 
draw pus from abscesses. 

Modern scientific research supports many of the tra- 
ditional uses for onion. Onion contains thiosulphinate, a 
compound that is effective in killing many common bac- 
teria, including Salmonella typhi , Pseudomonas aerigi- 
nosa, and Escherichia coli. This finding supports the 
folk use of onion to treat wounds and skin infections and 
possibly its use for an upset stomach. 

Even more supportive are small clinical studies on 
humans that show that both fresh onions and commercial 
onion extracts actually lower blood cholesterol levels, 
lower blood pressure and help prevent the formation of 
blood clots. Although these studies have been done on 
only a small number of people, they are consistently sup- 
ported by additional data from animal and test-tube stud- 


Allium cepa 


ies. In addition, many of these properties have been found 
in garlic (A. sativum) which is a close relative to onion. 

In 1990, scientists detected the presence of a com- 
pound in onion that partially blocks the development of in- 
flammation. In addition, laboratory animals were protected 
against induced asthma with fresh onion juice. Humans 
with asthma have also shown reduced allergy-induced con- 
striction of the airways when given an extract of onion. 
These findings support the traditional folk administration 
of onion to treat asthma and respiratory complaints. 

Some test-tube and small animal studies suggest that 
onion oil can stop the growth of tumors. Whether these 
results are applicable to humans remains to be seen, but 
in a 1989 study done in China, people who ate large 
amounts of vegetables in the Allium family appeared to 
have a significantly reduced rate of stomach cancer. 

Onion has also been shown to contain antioxidants, 
which are compounds that protect the body against free 
radicals. Free radicals are highly reactive molecules that 
destabilize other molecules and are associated with a 
number of degenerative diseases. 

The German Federal Health Agency’s Commission 
E, established in 1978 to independently review and eval- 
uate scientific literature and case studies pertaining to 
herb and plant medications, has approved onion as an an- 
tibacterial agent. Although many studies are promising, 
more information is needed before this endorsement is 
extended to other uses of onion. In general, however, it 
appears that onion is a healthful vegetable that may con- 
fer many medical benefits. 


Onion is a common vegetable, and can be served 
cooked or raw. For medicinal purposes, onion is available 
for internal use as a capsule or tablet containing dehydrated 
onion or onion extract. A recent study of the antioxidant 
activity of onion juice indicates that it is not affected by 
heating or boiling.For external use, the juice of fresh onion 
is used. A common dose is 1/4-1 cup of raw onions daily 
or one teaspoon of juice three times a day. In folk medi- 
cine, a cough syrup is made of raw onion liquid and honey. 


No special precautions are needed when taking 
onion medicinally. 

Side effects 

Although no allergic reactions to the bulb of the onion 
are reported, some people develop an allergic rash after han- 
dling the leaves of the plant. In addition, windblown parti- 
cles of onion leaves and skin have been shown to irritate the 
eyes of farm workers employed to harvest the onions. 



Antioxidant — An enzyme or other organic sub- 
stance that is capable of counteracting the damag- 
ing effects of oxidation in living tissue. Onion has 
been found to contain antioxidants. 

Diuretic — Any substance that increases the pro- 
duction of urine. 

Tincture — An alcohol-based extract prepared by 
soaking plant parts. 


There are no studies of the interaction of onion and 
conventional pharmaceuticals. However, given the long 
and widespread use of onion as a vegetable, serious in- 
teractions appear unlikely. 



Chevallier. Andrew. Encyclopedia of Medicinal Plants. Lon- 
don: Dorling Kindersley, 1996. 

PDR for Herbal Medicines. Montvale. N. J.: Medical Econom- 
ics Company, 1999. 

Peirce, Andrea. The American Pharmaceutical Association 
Practical Guide to Natural Medicines New York: William 
Morrow and Company, 1999. 


Hwang, Y. H., et al. “Suspended Onion Particles and Potential 
Corneal Injury in Onion Harvesters.” Archives of Environ- 
mental Health 57 (January-February 2002): 78-84. 
Racchi.M., et al. “Antiradical Activity of Water-Soluble Compo- 
nents in Common Diet Vegetables.” Journal of Agricultur- 
al and Food Chemistry 50 (February 2002): 1272-1277. 

Tish Davidson 
Rebecca J. Frey, PhD 

Allium sativa see Garlic 




Aloe vera , a member of the lily family, is a spiky, 
succulent, perennial plant. It is indigenous to eastern and 
southern Africa, but has been spread throughout many of 


the warmer regions of the world, and is also popularly 
grown indoors. There are about 300 identified species, 
but Aloe vera (“true aloe”) is the most popular for med- 
ical applications. It has also been known as Aloe vulgaris 
(“common aloe”) and Aloe barbadensis. The plant has 
yellow flowers and triangular, fleshy leaves with serrated 
edges that arise from a central base and may grow to 
nearly 2 ft (0.6 m) long. Each leaf is composed of three 
layers. A clear gel, that is the part of the plant used for 
topical application is contained within the cells of the 
generous inner portion. Anthraquinones, which exert a 
marked laxative effect, are contained in the bitter yellow 
sap of the middle leaf layer. The fibrous outer part of the 
leaf serves a protective function. 


Aloe vera has been in use for thousands of years, 
and is mentioned in records as long ago as 1750 B.c. 
Use of the plant is thought to have originated in Egypt 
or the Middle East. It was reputedly used in Egyptian 
embalming procedures, as drawings of Aloe vera have 
been found on cave walls in the region. Legend has it 
that Aloe vera was one of Cleopatra’s secrets for keep- 
ing her skin soft. Pliny and Dioscorides of ancient 
Greece wrote of the healing effects of this plant. Addi- 
tionally, Alexander the Great is said to have acquired 
Madagascar so that he could utilize the Aloe vera grow- 
ing there to treat soldiers’ wounds. It is also a remedy 
which has long been used in the Indian practice of 
Ayurvedic medicine. 

In the United States, Aloe vera was in use by the 
early 1800s, but primarily as a laxative. A turning point 
occurred in the mid- 1930s, when a woman with chronic 
and severe dermatitis resulting from x-ray treatments 
was healed by an application of Aloe vera leaf gel. Suc- 
cess with this patient encouraged trials with others suf- 
fering from radiation burns. Evidence of the effective- 
ness remained anecdotal until 1953, when Lushbaugh 
and Hale produced a convincing study, using Aloe vera 
to treat beta radiation lesions in rats. Other experimental 
protocols have been carried out using animals since that 
time, but there is little human research data to describe 
the degree of effectiveness of Aloe vera treatment. Some 
evidence suggests that it is especially helpful in the el- 
derly and other people with impaired health or failing 
immune systems. 

Biologic components 

Aloe vera contains a wealth of substances that are 
biologically active. The laxative, and in large doses, 
purgative, effects of Aloe vera latex are attributable to a 
group of chemicals known as the anthraquinones. Aloin, 


Leaves of an aloe plant. (Photograph by Robert J. Huffman. 
Field Mark Publications. Reproduced by permission.) 

barbaloin, and aloe-emodin, and aloectic acid, are a few 
of the anthraquinones contained in the latex layer. The 
latest, and perhaps most exciting component discovered 
in Aloe vera is a biologically active polysaccharide 
known as acetylated mannose, or acemannan. This sub- 
stance has been shown to be a highly effective immune 
stimulant, with activity against the viruses causing the 
flu, measles, and early stages of AIDS. It has been used 
effectively against some veterinary cancers, most no- 
tably sarcoma, and is being investigated as an agent to be 
used to treat cancer in humans. Acemannan is one of 
many saccharides contained in Aloe vera. Some of the 
others are arabinose, cellulose, galactose, mannose, and 
xylose. Prostaglandins are a third important set of com- 
pounds, and are thought to play a major role in wound 
healing. Aloe vera also contains fatty acids, enzymes, 
amino acids, vitamins, minerals, and other substances. 
The interaction of all these components produces a fa- 
vorable environment for wound healing. 

General use 

Few botanicals are as well known or as highly 
thought of as the Aloe vera plant. Throughout recorded 
history, it has been used to keep skin beautiful and re- 
store it to health. A frequent moisturizing ingredient in 
cosmetics and hair care products, it also promotes the 
healing of burns and superficial wounds, but should not 
be used on deep or surgical wounds of punctures. Topi- 
cal application has been successful in treatment of sun- 
burn, frostbite, radiation injuries, some types of der- 
matitis, psoriasis, cuts, insect stings, poison ivy, ulcera- 
tions, abrasions, and other dermatologic problems. Heal- 
ing is promoted by the anti-inflammatory components, 
including several glycoproteins and salicylates, and sub- 
stances that stimulate growth of skin and connective tis- 
sue. Aloe vera contains a number of vitamins and miner- 




als that are necessary to healing, including vitamin C, 
vitamin E, and zinc. It also exerts antifungal and an- 
tibacterial effects, and thus helps to prevent wound in- 
fections. One study showed it to have a little more activ- 
ity than the antiseptic silver sulfadiazine against a num- 
ber of common bacteria that can infect the skin. It has 
moisturizing and pain relieving properties for the skin 
lesions, in addition to healing effects. 

Aloe vera gel products may also be used internally. 
They should not contain the laxative chemicals found in 
the latex layer. There is some evidence that Aloe vera 
juice has a beneficial effect on peptic ulcers, perhaps in- 
hibiting the causative bacteria, Helicobacter pylori. It ap- 
pears to have a soothing effect on the ulcer, and interferes 
with the release of hydrochloric acid by the stomach. 
Colitis and other conditions of the intestinal tract may 
also respond favorably to the internal use of gel products. 
Aloe vera has been shown to exert a stabilizing effect on 
blood sugar in studies done on mice, indicating a possible 
place for it in the treatment of diabetes. One study sug- 
gested that giving Aloe vera extract orally to patients with 
asthma who are not dependent on steroids could improve 
symptoms. A health care provider should be consulted 
about these uses. Other suggested, but insufficiently 
proven, indications for oral Aloe vera gel include preven- 
tion of kidney stones and relief of arthritis pain. 

Aloe vera products derived from the latex layer are 
taken orally for the laxative effect. They can cause 
painful contractions of the bowel if taken in high doses. 
Milder measures are recommended first. 

The concentration of the immune stimulant aceman- 
nan is variable in the natural plant, as well as gel and 
juice products, but it is also available in a purified, stan- 
dardized, pharmaceutical grade form. An injectable type 
is used in veterinary medicine to treat fibrosarcoma and 
feline leukemia, a condition caused by a virus in the 
same family as AIDS. 


Commercial products 

Choosing effective Aloe vera products can be chal- 
lenging. Once a leaf is cut, enzymes start to break down 
some of the long chain sugars which make Aloe vera gel 
an effective healing product, so it is important for the 
plant to have been properly handled and stabilized. Ask 
for help in selecting a reputable company to buy from. 
When shopping for a product to use for topical healing, 
look for Aloe vera to be one of the first products listed to 
ensure that it is not too dilute to be efficacious. Commer- 
cial, stabilized gel products may not work as well as the 
fresh gel, but cold processing is thought to best retain the 


beneficial properties. The FDA does not regulate label- 
ing of Aloe vera products. 

Aloe vera juice is most often the form of the gel that 
is used internally. At least half of the juice should be 
Aloe vera gel. If laxative properties are not desired, be 
sure that the juice does not contain latex. A product that 
is made from the whole leaf does not necessarily contain 
anthraquinones from the latex layer, as those are water- 
soluble and can be separated out during processing. Cap- 
sules and tinctures of the gel are also available. Oral 
forms of the latex extract are generally capsules, as it is 
extremely bitter. 

Growing aloe at home 

For common topical use, keeping an Aloe vera plant 
at home is one of the easiest ways to get the freshest and 
most concentrated gel. It is easy to cultivate, requiring 
only good drainage, mild temperatures, and occasional 
watering. Bring the plant inside if outside temperatures 
are less than 40°F (4.4°C). It will tolerate either full or 
partial sunlight, but will require more frequent watering 
in full sun. Water it only when the soil has become dry. 
To use the gel, break off a leaf and cut it lengthwise to 
expose the inner layer. Scoop the gel out and apply gen- 
erously to the area needing treatment. Discard whatever 
gel is not used immediately, as it will degenerate quickly. 
The inner portion of the leaf may also be applied directly 
to a skin injury, and bound to it. 


Aloe vera gel is generally safe for topical use, but it 
is best to apply it to a small area first to test for possible 
allergic reaction. Stinging and generalized dermatitis 
may result in individuals who are sensitive to it. The vast 
majority of the warnings apply only to products contain- 
ing anthraquinones, such as aloin and barbaloin (as well 
as the numerous others), which are found in the latex 
layer of the plant. Aloe vera latex should not be used in- 
ternally by women who are pregnant or lactating, or by 
children. This product can cause abortion or stimulate 
menstruation. It may pass into the milk of breastfeeding 
mothers. People who have abnormal kidney function, 
heart disease, or gastrointestinal diseases are best ad- 
vised to avoid any product containing Aloe vera latex or 
anthraquinones. Prolonged, internal use in high doses 
may produce tolerance so that more is required to obtain 
the laxative effect. Be aware of the possibility that any 
Aloe vera product for internal use that is supposed to 
contain only the gel portion can become contaminated 
by the anthraquinones of the latex layer. For this reason, 
people who have a contraindication for using Aloe vera 
latex should use caution when taking an Aloe vera gel 
product internally. 



AIDS — Acronym for acquired immune deficiency 
syndrome, the disease caused by human immun- 
odeficiency viruses (HIV). 

Aloe concentrate — Aloe gel from which the water 
has been removed. 

Aloe gel — Thick, undiluted substance from the 
central portion of the aloe leaf. 

Aloe juice — A product for oral use, which is com- 
posed of at least 50% aloe gel. 

Aloe latex — Bitter yellow sap from the middle leaf 

Anthraquinone — A group of chemicals contained 
in the latex of the Aloe plant and having strong 
laxative properties. 

Hyperglycemia — High blood sugar. 

Side effects 

Internal use of Aloe vera latex may turn the urine 
red, and may also cause abdominal pain or cramps when 
products containing anthraquinones are consumed. 


Chronic internal use of products containing Aloe 
vera latex may increase the likelihood of potassium loss 
when used concomitantly with diuretics or corticos- 
teroids. It may possibly compound the risk of toxicity 
when used with cardiac glycosides (both prescription 
and herbal types) and antiarrhythmic drugs. Absorption 
of other oral medications can be decreased. Aloe vera 
latex should not be used with other laxative herbs, which 
may also lead to excessive potassium loss. 

Internal use of Aloe vera gel can cause changes in 
blood sugar, so diabetics should monitor blood glucose 
levels during use, particularly if insulin or other pharma- 
ceuticals are being used to control hyperglycemia. 

Topical Aloe vera may enhance the effect of topical 
corticosteroids and allow a reduction in the amount of 
the steroid being used. 



Bratman, Steven and David Kroll. Natural Health Bible. Prima 
Health, 1999. 

Chevallier, Andrew. The Encyclopedia of Medicinal Plants. DK 
Publishing Inc., 1996. 


Jellin, J.M.. F. Batz, and K. Hitchens. Pharmacist’ s Letter/Pre- 
scriber's Letter Natural Medicines Comprehensive Data- 
base. Therapeutic Research Faculty, 1999. 

Murray, Michael T. The Heating Power of Herbs. Prima Health, 

Judith Turner 

Alopecia see Hair loss 



Alpha-hydroxy is a chemical compound derived 
from fruit and milk sugars. Alpha-hydroxy acids (AHAs) 
are use in topical skin care products to exfoliate, or 
slough away, dead skin cells and promote collagen 
growth. They can be useful in promoting smoother, 
even-toned skin and may reduce the appearance of wrin- 
kles and fine lines in some individuals. 

AHAs are available in a number of different synthet- 
ic and natural formulations. Lactic AHA is derived from 
milk products, while glycolic AHA is derived from sug- 
arcane. Other AHA compounds include citric acid (from 
fruit) and malic acid (from apples). 

General use 

AHAs work by removing dead cells at the surface of 
the skin. In higher concentrations, it promotes collagen 
production, which may reduce the appearance of fine 
lines and wrinkles in the skin. The acids penetrate deep 
into the skin, where they actually begin to damage skin 
cells. This skin damage triggers the production of colla- 
gen, a fibrous protein and a building block of tissue and 
skin, as the body attempts to repair the cell damage. 

Cosmetic, over-the-counter preparations of alpha- 
hydroxy must contain less than 10% of the compound 
according to U.S. Food and Drug Administration (FDA) 
regulations. This is a high enough concentration to pro- 
mote exfoliation, but not potent enough to generate col- 
lagen production. The concentration of AHA required to 
produce this effect is only available with a prescription 
from a dermatologist or licensed healthcare professional, 
or through professionally administered treatments from a 
licensed cosmetologist. 

Guidelines recommended by the trade regulatory as- 
sociation Cosmetic Ingredient Review have been adapted 
by the U.S. FDA for consumer AHA products. The Cos- 
metic Ingredient Review is a self-regulating agency es- 




tablished by the Cosmetic, Toiletry, and Fragrance Asso- 
ciation to set safety standards for ingredients used by the 
cosmetic industry. Trained cosmetologists are permitted 
to use AHA concentrations as high as 30%, provided 
these products have a pH level of 3.0 or higher. Health- 
care professionals such as dermatologists typically use 
concentrations as high as 50-70%. 


AHA preparations are available in over the counter 
and prescription gel, lotion, toner, and cream formula- 
tions. An over-the-counter formula that contains between 
5-8% AHA may be more effective. Because FDA regu- 
lates these products as cosmetics and not drugs, the man- 
ufacturer is not required to list the strength of AHA on 
the package labeling. However, product ingredients must 
be listed sequentially in the order of highest concentra- 
tion, so products which list AHA compounds second or 
third are usually more beneficial than those who list 
them in the middle to end of the ingredient list. 

The pH level of an AHA product is also important to 
the product’s effectiveness. A higher pH level means the 
product is less acidic and gentler on the skin, however, a 
higher pH can also lessen the overall potency of the 
product. The Cosmetic Ingredient Review guidelines for 
AHA products specify that consumer AHA products 
must have a pH of 3.5 or more. 

Depending on their skin type, certain individuals 
may find some carrier formulas (i.e., cream, gel, lotion, 
toner) more effective than others. Those with dry skin 
may find moisturizing AHA creams and lotions more ef- 
fective, while individuals with oily skin may prefer a less 
oily toner or gel. 

Individuals who are prescribed AHA formulations 
by a healthcare professional should follow their doctor’s 
directions for use of the product. 


Buy only those AHA products that conform to the 
Cosmetic Ingredient Review and FDA recommended 
guidelines of 10% or less AHA with a 3.5 or higher pH 

Over-the-counter AHA preparations (those with less 
than 10% AHA) are designated as cosmetics, rather than 
drugs, by the U.S. FDA, and therefore do not have to un- 
dergo the rigorous testing, review, and approval process 
required of medical products. In addition, labeling for 
cosmetics does not require a listing of the concentration 
of ingredients, although some manufacturers provide this 
information on their labeling voluntarily. Individuals 
should try to purchase AHA products that provide de- 


tailed ingredient and concentration information to ensure 
they are purchasing true AHA ingredients in a therapeu- 
tic concentration. In addition, if an individual experi- 
ences a reaction to an AHA product, they can use de- 
tailed labeling to decide if a lower concentration of the 
product is available and may be right for them. 

Individuals who are considering using AHA prod- 
ucts for the first time, or who are switching the type of 
AHA product they use, should perform a skin patch test 
to check for skin sensitivity to the substance. A small, 
dime sized drop of the AHA product should be applied 
to a small patch of skin inside the elbow or wrist. The 
skin patch should be monitored for 24 hours to ensure no 
excessive redness, swelling, blistering, or rash occurs. If 
a reaction does occur, the test can be repeated with an 
AHA product with a lower alpha-hydroxy acid concen- 
tration. Individuals who experience a severe reaction to a 
skin patch test of AHA are advised not to use the prod- 
uct. A dermatologist or other healthcare professional 
may be able to recommend a suitable alternative. 

AHA products may increase sun sensitivity. Individ- 
uals using AHA products should use a high SPF (at least 
15 SPF) sunscreen over the AHA formula to protect 
against burning. Sunscreen should be applied no less 
than 15 minutes after the AHA formula is applied to pre- 
vent neutralizing the acids. Shading the face with a wide- 
brimmed hat may also be useful. Results of a 1999 FDA 
study on the use of AHA and UV damage showed that, 
while AHA decreases the time required for skin to begin 
to burn, discontinuing use of the AHA product returned 
skin to normal within a week. 

Exfoliative products should be used with care, as 
over-exfoliation can cause damage to the skin. AHA 
products should not be combined with other exfoliative 
products such as facial scrubs, buff pads, or loofahs. In 
addition, individuals should only use one AHA product 
at a time. 

Higher concentration prescription AHA products 
have a great likelihood of producing side effects, so indi- 
viduals taking them should contact their healthcare 
provider immediately if they experience burning, red- 
ness, or any other reaction to the product. 

Individuals who experience adverse reactions to 
AHA treatments should report them to both the manu- 
facturer of the product and to the FDA’s Office of Cos- 
metics and Colors. A patient’s dermatologist or health- 
care provider can also make this report anonymously for 
the patient. Although these products do not require FDA 
approval for market release, FDA is responsible for mon- 
itoring their safety and can initiate a product recall or re- 
moval for a specific brand or formulation if enough ad- 
verse effects occur to make these steps necessary. 



Contact dermatitis — Inflammation and redness of 
the skin caused by an irritating substance. 

Exfoliate — To shed skin. In skin care, the term ex- 
foliate describes the process of removing dead 
skin cells. 

pH — An abbreviation for potential of hydrogen. A 
neutral pH is a pH of 7. Levels below 7 are con- 
sidered acidic, and those above 7 alkaline. FDA 
recommends that over-the-counter alpha-hydroxy 
products have a pH of at least 3.5. 

AHA chemical peels and other high concentration 
AHA treatments should only be administered by a li- 
censed cosmetologist, licensed dermatologist, or other 
qualified healthcare professional. 

Side effects 

Possible side effects of AHA products include: 

• Increased sun sensitivity. Individuals who use AHA are 
often more sensitive to UV rays. 

• Excessive redness and burning. In high concentrations 
and/or with individuals with sensitive skin, AHA can 
cause redness, burning, and even blistering. 

• Swelling. AHA products can cause swelling of the skin 
and/or eyes. 

• Contact dermatitis. AHA can cause an allergic skin re- 
action characterized by rash and itching in some indi- 

• Skin discoloration. Some cases of AHA-related skin 
discoloration have been reported. 

The FDA has sponsored a joint study with the Na- 
tional Toxicology Program to further assess the long- 
term consequences of AHA product use. Results of the 
study were not yet available as of July 2000. 


There are no known interactions between alpha-hy- 
droxy acid products and other medications and sub- 
stances when administered in recommended strengths. 
However, because over-the-counter AHA products are 
considered cosmetics and not pharmaceuticals, existing 
research on possible interactions is minimal. 

Alpha-hydroxy products may enhance the effects of 
other products or medications with similar therapeutic 




Callan, Annette, ed. All About Skin Care. Oxford, UK: Oxford 
University Press, 2000. 


Kurtzweil, Paula. “Alpha Hydroxy Acids.” FDA Consumer. 32, 
No. 2 (March/April 1998): 30-6. 


Cosmetic Ingredient Review. 1101 17th St. N.W. Suite 310, 
Washington D.C. 20036-4702. (202) 331-0651. http:// 

U.S. Food and Drug Administration. Office of Consumer Af- 
fairs. FDA (HFE-88), 5600 Fishers Lane, Rockville, MD 
20857. (301) 827-5006. To report ad- 
verse effects of a cosmetic product, call: (800) 270-8869. 

Paula Ford-Martin 

Alternate nostril breathing see Breath 

Althea occicinal see Marsh mallow 

Alzheimer's disease 


Alzheimer’s disease (AD) is the most common form 
of dementia, a neurologic disease characterized by loss 
of mental ability severe enough to interfere with normal 
activities of daily living, lasting at least six months, and 
not present from birth. AD usually occurs in old age, and 
is marked by a decline in cognitive functions such as re- 
membering, reasoning, and planning. 


A person with AD usually has a gradual decline in 
mental functions, often beginning with slight memory 
loss, followed by losses in the ability to maintain employ- 
ment, to plan and execute familiar tasks of daily living, 
and to reason and exercise judgment. Communication 
ability, mood, and personality may also be affected. Most 
people who have AD die within eight years of their diag- 
nosis, although that interval may be as short as one year 
or as long as 20 years. AD is the fourth leading cause of 
death in adults after heart disease, cancer, and stroke. 

Between two and four million Americans have AD; 
that number is expected to grow to as many as 14 million 
by the middle of the twenty-first century as the popula- 
tion as a whole ages. While a small number of people in 


Alzheimer's disease 

Alzheimer's disease 

Diseased tissue from the brain of an Alzheimer’s patient 
showing senile plaques within the brain’s gray matter. 

(Photograph by Cecil Fox, Photo Researchers, Inc. Reproduced 
by permission.) 

their 40s and 50s develop the disease (called early-onset 
AD), AD predominantly affects the elderly. AD affects 
about 3% of all people between ages 65 and 74, about 
19% of those between 75 and 84, and about 47% of 
those over 85. Slightly more women than men are affect- 
ed with AD, but this may be because women tend to live 
longer, leaving a higher proportion of women in the most 
affected age groups. 

The cost of caring for a person with AD is consider- 
able, and has been estimated at approximately $174,000 
per person over the course of the disease. Most people 
with AD are cared for at home; the cost of extended 
nursing home care adds substantially to this estimate. 

Causes & symptoms 

The cause or causes of AD are unknown. Some 
strong leads have been found through recent research, 
and these have also given some theoretical support to 
several new experimental treatments. 

AD affects brain cells, mostly those in brain regions 
responsible for learning, reasoning, and memory. Autop- 
sies of persons with AD show that these regions of the 
brain become clogged with two abnormal structures — 
neurofibrillary tangles and senile plaques. Neurofibril- 
lary tangles are twisted masses of protein fibers inside 
nerve cells, or neurons. Senile plaques are composed of 
parts of neurons surrounding a group of brain proteins 
called beta-amyloid deposits. While it is not clear exact- 
ly how these structures cause problems, some re- 
searchers now believe that their formation is in fact re- 
sponsible for the mental changes of AD, presumably by 
interfering with the normal communication between 
neurons in the brain. 

What triggers the formation of plaques and tangles 
is unknown, although there are several possible candi- 
dates. Inflammation of the brain may play a role in their 
development, and use of nonsteroidal anti-inflammatory 
drugs (NSAIDs) seems to reduce the risk of developing 
AD. Restriction of blood flow may be part of the prob- 
lem, perhaps accounting for the beneficial effects of es- 
trogen that increases blood flow in the brain, among its 
other effects. Highly reactive molecular fragments called 
free radicals damage cells of all kinds, especially brain 
cells, which have smaller supplies of protective antioxi- 
dants thought to protect against free radical damage. 

Several genes have been implicated in AD, includ- 
ing the gene for amyloid precursor protein, or APP, re- 
sponsible for producing amyloid. Mutations in this gene 
are linked to some cases of the relatively uncommon 
early-onset forms of AD. In 2001, scientists discovered a 
new rare mutation of the APP gene that might lead to 
new understanding on how the disease develops and new 
treatment possibilities. Other cases of early-onset AD are 
caused by mutations in the gene for another protein, 
called pre-senilin. AD eventually affects nearly everyone 
with Down syndrome, caused by an extra copy of chro- 
mosome 21. Other mutations on other chromosomes 
have been linked to other early-onset cases. 

Potentially the most important genetic link was dis- 
covered in the early 1990s on chromosome 19. A gene 
on this chromosome, called apoE, codes for a protein in- 
volved in transporting lipids into neurons. ApoE occurs 
in at least three forms — apoE2, apoE3, and apoE4. Each 
person inherits one apoE from each parent, and therefore 
can either have one copy of two different forms, or two 
copies of one. Compared to those without ApoE4, people 
with one copy are about three times as likely to develop 
late-onset AD, and those with two copies are almost four 
times as likely to do so. Despite this important link, not 
everyone with apoE4 develops AD, and people without it 
can still have the disease. Why apoE4 increases the 
chances of developing AD is not known. 

There are several risk factors that increase a per- 
son’s likelihood of developing AD. The most significant 
one is age; older people develop AD at much higher rates 
than younger ones. Another risk factor is having a family 
history of AD, Down syndrome, or Parkinson’s disease. 
People who have had head trauma or hypothyroidism 
may manifest the symptoms of AD more quickly. No 
other medical conditions have been linked to an in- 
creased risk for AD. 

Many environmental factors have been suspected of 
contributing to AD, but population studies have not borne 
out these links. Among these have been pollutants in 
drinking water, aluminum from commercial products, and 



metal dental fillings. To date, none of these factors has 
been shown to cause AD or increase its likelihood. Further 
research may yet turn up links to other environmental cul- 
prits, although no firm candidates have been identified. 

The symptoms of AD begin gradually, usually with 
short-term memory loss. Occasional memory lapses are 
of course common to everyone, and do not by them- 
selves signify any change in cognitive function. The per- 
son with AD may begin with only the routine sort of 
memory lapse — forgetting where the car keys are — but 
progress to more profound or disturbing losses, such as 
forgetting that he or she can even drive a car. Becoming 
lost or disoriented on a walk around the neighborhood 
becomes more likely as the disease progresses. A person 
with AD may forget the names of family members, or 
forget what was said at the beginning of a sentence by 
the time he hears the end. 

As AD progresses, other symptoms appear, includ- 
ing inability to perform routine tasks, loss of judgment, 
and personality or behavior changes. Some patients have 
trouble sleeping and may suffer from confusion or agita- 
tion in the evening (“sunsetting”). In some cases, people 
with AD repeat the same ideas, movements, words, or 
thoughts, a behavior known as perseveration. Some pa- 
tients may exhibit inappropriate sexual behaviors. In the 
final stages of the disease, people may have severe prob- 
lems with eating, communicating, and controlling their 
bladder and bowel functions. 

The Alzheimer’s Association has developed a list of 10 
warning signs of AD. A person with several of these symp- 
toms should see a physician for a thorough evaluation: 

• memory loss that affects job skills 

• difficulty performing familiar tasks 

• problems with language 

• disorientation of time and place 

• poor or decreased judgment 

• problems with abstract thinking 

• misplacing things 

• changes in mood or behavior 

• changes in personality 

• loss of initiative 

Other types of dementing illnesses, including some 
that are reversible, can cause similar symptoms. It is im- 
portant for the person with these symptoms to be evalu- 
ated by a professional who can weigh the possibility that 
his or her symptoms may have another cause. Approxi- 
mately 20% of those originally suspected of having AD 
turn out to have some other disorder; about half of these 
cases are treatable. 



Diagnosis of AD is complex, and may require office 
visits to several different specialists over several months 
before a diagnosis can be made. While a confident provi- 
sional diagnosis may be made in most cases after thor- 
ough testing, AD cannot be definitively diagnosed until 
autopsy examination of the brain for senile plaques and 
neurofibrillary tangles. 

The diagnosis of AD begins with a thorough physi- 
cal exam and complete medical history. Except in the 
disease’s earliest stages, accurate history from family 
members or caregivers is essential. Since there are both 
prescription and over-the-counter drugs that can cause 
the same mental changes as AD, a careful review of the 
patient’s drug, medicine, and alcohol use is important. 
AD-like symptoms can also be provoked by other med- 
ical conditions, including tumors, infection, and demen- 
tia caused by mild strokes (multi-infarct dementia). 
These possibilities must be ruled out as well through ap- 
propriate blood and urine tests, brain magnetic resonance 
imaging (MRI) or computed tomography scans (CT), 
tests of the brain’s electrical activity (electroencephalo- 
graphs or EEGs), or other tests. 

In 2001, researchers demonstrated that postitron 
emission tomography (PET) scans could help predict who 
might develop memory impairment. Although PET scan- 
ning is a relatively new and expensive technology, it is be- 
coming more readily available. Several types of oral and 
written tests are used to aid in the AD diagnosis and to fol- 
low its progression, including tests of mental status, func- 
tional abilities, memory, and concentration. Still, the neu- 
rologic exam is normal in most patients in early stages. 

One of the most important parts of the diagnostic 
process is to evaluate the patient for depression and 
delirium, since each of these can be present with AD, or 
may be mistaken for it. (Delirium involves a decreased 
consciousness or awareness of one’s environment.) De- 
pression and memory loss are both common in the elder- 
ly, and the combination of the two can often be mistaken 
for AD. Depression can be treated with drugs, although 
some antidepressants can worsen dementia if it is pre- 
sent, further complicating both diagnosis and treatment. 

A genetic test for the ApoE4 gene is available, but is 
not used for diagnosis, because possessing even two 
copies does not ensure that a person will develop AD. 


The mainstay of treatment for a person with AD con- 
tinues to be the establishment of daily routines and good 
nursing care, providing both physical and emotional sup- 
port for the patient. Modifications of the home to increase 


Alzheimer's disease 

Alzheimer's disease 

safety and security are often necessary. The caregiver also 
needs support. Regular medical care by a practitioner 
with a non-defeatist attitude toward AD is important so 
that illnesses can be diagnosed and treated properly. 

People with AD are also often depressed or anxious, 
and may suffer from sleeplessness, poor nutrition, and 
general poor health. Each of these conditions is treatable 
to some degree. It is important for the person with AD to 
eat well and continue to exercise. Professional advice 
from a nutritionist may be useful to provide healthy, 
easy-to-prepare meals. Finger foods may be preferable to 
those requiring utensils to be eaten. Regular exercise (su- 
pervised for safety if necessary) promotes overall health. 
A calm, structured environment with simple tools that 
support orientation (like calendars and clocks) may re- 
duce anxiety and increase safety. 

Diet and supplements 

DIET. The incidence of AD is lower in countries 
whose citizens have a diet that is lower in fats and calo- 
ries. There have been a few reports that a diet rich with 
fish improves mental function in patients with AD or de- 
mentia. AD patients treated with essential fatty acids 
showed greater improvement in mood and mental func- 
tion than patients on placebo. Because of its disease-pre- 
venting properties, red wine in moderation may be bene- 
ficial to AD patients. 

VITAMIN E. Studies have shown that AD patients 
have lower blood levels of vitamin E than age matched 
control subjects. A large, two year study of moderately 
affected AD patients found that taking 2,000 IU of vita- 
min E daily significantly delayed disease progression as 
compared to patients taking placebo. This delay was 
equivalent to that seen with patients taking the drug se- 
legiline. Vitamin E is also thought to delay AD onset. 
High levels of vitamin E put the patient at higher risk for 
bleeding disorders. 

THIAMINE (VITAMIN B,). Several small studies to 
determine the effectiveness of thiamine (vitamin on 
AD have been carried out. Daily doses of 3 g for two to 
three months have improved mental function and AD as- 
sessment scores. Other studies have shown that thiamine 
had no effect on AD patients. Side effects include nau- 
sea and indigestion. 

COBALAMIN (VITAMIN B 12 ). Although results are 
conflicting, some studies have found that AD patients 
have lower levels of cobalamin (vitamin B 12 ) than oth- 
ers. Some studies have shown that cobalamin supple- 
mentation improves memory and mental function in AD 
patients whereas other studies have found no effect. 

ACETYL-L-CARNITINE. Acetyl-L-carnitine is similar 
in structure to the neurotransmitter acetyl-choline. Stud- 


ies have shown that 2 g or 3 g of acetyl-L-camitine daily 
slows the progression of AD, especially in patients who 
developed the disease before age 66. Patients who devel- 
oped disease after 66 years of age worsened with treat- 
ment. Side effects include increased appetite, body 
odor, and rash. 

DHEA. DHEA (dehydroepiandrosterone) is a steroid 
hormone. There may be a link between decreasing levels 
of DHEA in the elderly and development of AD. Studies 
on the effect, if any, of DHEA on AD are needed. Side 
effects include acne, hair growth, irritability, insomnia, 
headache, and menstrual irregularity. 

MELATONIN. Melatonin is a hormone that helps to 
regulate mood and sleep cycles. The effect of melatonin 
treatment on AD is unknown but it may be beneficial in 
regulating sleep cycles. The usual dose is 3 mg taken one 
to two hours before bedtime. Side effects are drowsiness, 
confusion, headache, decreased sex drive, and decreased 
body temperature. 

Herbals and Chinese medicine 

GINKGO. Ginkgo, the extract from the Ginkgo hilo- 
ha tree is the most commonly used herbal treatment for 
AD. Several studies have been performed to test the ef- 
fectiveness of ginkgo for treating AD. The dose range 
studied were 120-160 mg daily divided into three doses. 
Although results have been mixed, the evidence suggests 
that ginkgo is an effective treatment for patients with 
mild to moderate AD. Side effects are not common but 
include headache, allergic skin reaction, and gastroin- 
testinal disturbance. Ginkgo also decreases blood coagu- 
lation. Individuals with coagulation or platelet disorders 
should use extreme caution and consult a physician be- 
fore using ginkgo. 

PHYTOESTROGENS. Phytoestrogens may be benefi- 
cial in the treatment of AD based on the findings that 
women with AD who are on hormone replacement thera- 
py have improved mental function and mood. Estrogens 
may prevent AD, therefore, phytoestrogens may have the 
same effect. Phytoestrogens are mainly found in soy 

CLUBMOSS. Huperzine A is a compound isolated 
from clubmoss ( Huperzia serrata). Studies have shown 
that taking 0. 1-0.4 mg daily improves mental function in 
AD patients. Side effects are nausea, muscle cramps, 

vomiting, and diarrhea. 


Music therapy has been shown to be effective in 
treating the depression, agitation, wandering, feelings of 
isolation, and memory loss associated with AD. AD pa- 


tients have benefited from listening to favorite music or 
participating in musical activity. Participation in a music 
therapy group was more effective at improving memory 
and decreasing agitation than being part of a verbal (talk- 
ing) group. 

A wide variety of other therapies have been benefi- 
cial in the treatment of the psychologic symptoms of 
AD. These include: 

• Light therapy in the evening to improve sleep cycle dis- 

• Supportive therapy through touch, compliments, and 
displays of affection. 

• Sensory stimulation through massage and aromatherapy. 

• Socio-environmental therapies use activities fitted to 
previous interests, favorite foods, and pleasant sur- 

• Cognitive therapy to reduce negative perceptions and 
learn coping strategies. 

• Insight-oriented psychotherapy addresses the patient’s 
awareness of his or her disease. 

• Dance therapy. 

• Validation therapy. 

• Reminiscence therapy. 

• Reality-oriented therapy. 

Nursing care and safety 

The nursing care required for a person with AD is 
easy to learn. Caregivers will usually need to spend in- 
creasing amounts of time grooming the patient as the dis- 
ease progresses. The patient may require assisted feeding 
early on to make sure that he or she is taking in enough 
nutrients. Later on, as movement and swallowing become 
difficult, a feeding tube may be placed into the stomach 
through the abdominal wall. A feeding tube requires more 
attention, but is generally easy to care for if the patient is 
not resistant to its use. Incontinence becomes the most dif- 
ficult problem to deal with at home, and is a principal rea- 
son for pursuing nursing home care. In the early stages, 
limiting fluid intake and increasing the frequency of toilet- 
ing can help. Careful attention to hygiene is important to 
prevent skin irritation and infection from soiled clothing. 

In all cases, a person diagnosed with AD should not 
be allowed to drive, because of the increased potential for 
accidents and the increased likelihood of wandering very 
far from home while disoriented. In the home, simple 
measures such as grab bars in the bathroom, bed rails on 
the bed, and easily negotiable passageways can greatly 
increase safety. Electrical appliances should be un- 
plugged and put away when not in use. Matches, lighters, 


knives, or weapons should be stored safely out of reach. 
The hot water heater temperature may be set lower to pre- 
vent accidental scalding. A list of emergency numbers, 
including the poison control center and the hospital emer- 
gency room, should be posted by the phone. 

Care for the caregiver 

Family members or others caring for a person with 
AD have an extremely difficult and stressful job that be- 
comes harder as the disease progresses. It is common for 
caregivers to develop feelings of anger, resentment, guilt, 
and hopelessness, in addition to the sorrow they feel for 
their loved one and for themselves. Depression is an ex- 
tremely common consequence. Becoming a member of 
an AD caregivers’ support group can be one of the most 
important things a family member does, not only for him 
or herself, but for the person with AD as well. The loca- 
tion and contact numbers for AD caregiver support 
groups are available from the Alzheimer’s Association; 
they may also be available through a local social service 
agency, the patient’s physician, or pharmaceutical com- 
panies that manufacture the drugs used to treat AD. 
Medical treatment for depression may be an important 
adjunct to group support. 

Outside help, nursing homes, and 

governmental assistance 

Most families eventually need outside help to relieve 
some of the burden of around-the-clock care for a person 
with AD. Personal care assistants, either volunteer or 
paid, may be available through local social service agen- 
cies. Adult daycare facilities are becoming increasingly 
common. Meal delivery, shopping assistance, or respite 
care may be available as well. Many families consider 
nursing home care when AD advances to the late-stage. 

Several federal government programs may ease the 
cost of caring for a person with AD, including Social Se- 
curity Disability, Medicare, and Supplemental Security 
Income. Each of these programs may provide some as- 
sistance for care, medication, or other costs, but none of 
them will pay for nursing home care indefinitely. Medic- 
aid is a state-funded program that may provide for some 
or all of the cost of nursing home care, although there are 
important restrictions. Details of the benefits and eligi- 
bility requirements of these programs are available 
through the local Social Security or Medicaid office, or 
from local social service agencies. 

Allopathic treatment 

The only two drugs approved for AD, tacrine hy- 
drochloride (Cognex) and donepezil hydrochloride (Ari- 
cept), increase the brain levels of the neurotransmitter 


Alzheimer's disease 

Alzheimer's disease 

acetylcholine, thereby increasing the communication ability 
of the remaining neurons. These drugs can modestly in- 
crease cognition and improve the ability to perform normal 
activities of daily living. The most significant side effect of 
tacrine is an increase in the liver enzyme alanine amino- 
transferase (ALT). Patients taking tacrine must have a 
weekly blood test to monitor their ALT levels. Other fre- 
quent side effects include nausea, vomiting, diarrhea, ab- 
dominal pain, indigestion, and skin rash. Donepezil has 
two advantages over tacrine: fewer side effects and once 
daily dosing. Donepezil does not appear to affect liver en- 
zymes and the frequency of abdominal side effects is lower. 

Estrogen, the female sex hormone, is widely pre- 
scribed for post-menopausal women to prevent osteo- 
porosis. Several preliminary studies have shown that 
women taking estrogen have lower rates of AD, and 
those who develop AD have a slower progression and 
less severe symptoms. 

Preliminary studies have also suggested a reduced 
risk for developing AD in older people who regularly use 
nonsteroidal anti-inflammatory drugs (NSAIDs), includ- 
ing aspirin, ibuprofen (Advil), and naproxen (Aleve), al- 
though not acetaminophen. A 2001 study reported that 
those subjects who used NSAIDs for at least two years 
were up to 80% less likely to develop Alzheimer’s. Fur- 
ther study on the effects of NSAIDs on AD are underway. 

Selegiline, a drug used in the treatment of Parkin- 
son’s disease, appears to slow the development of AD. 
Selegiline is thought to act as an antioxidant, preventing 
free radical damage. However, it also acts as a stimulant, 
making it difficult to determine whether the delay in 
onset of AD symptoms is due to protection from free 
radicals or to the general elevation of brain activity from 
the stimulant effect. 

Psychiatric symptoms, such as depression, anxiety, 
hallucinations (seeing or hearing things that aren’t 
there), and delusions (false beliefs) may be treated with 
drugs if necessary. 

Expected results 

While Alzheimer’s disease may not be the direct 
cause of death, the generally poorer health of a person 
with AD increases the risk of life-threatening infection, 
including pneumonia. In addition, other diseases com- 
mon in old age (cancer, stroke, and heart disease) may 
lead to more severe consequences in a person with AD. 
On average, people with AD live eight years past their 
diagnosis, with a range from 1-20 years. 


There is currently no sure way to prevent Alzheimer’s 
disease, though some of the drug treatments discussed 



Acetylcholine — One of the substances in the 
body that helps transmit nerve impulses. 

Dementia — Impaired intellectual function that in- 
terferes with normal social and work activities. 
Neurofibrillary tangle — Twisted masses of pro- 
tein inside nerve cells that develop in the brains of 
people with AD. 

Neuron — A nerve cell. 

Senile plaque — Structures composed of parts of 
neurons surrounding brain proteins called beta- 
amyloid deposits and found in the brains of peo- 
ple with AD. 

above may eventually be proven to reduce the risk of de- 
veloping the disease. The most likely current candidates 
are estrogen, phytoestrogens, NSAIDs, vitamin E, and se- 
legiline. In 2001, researchers found preliminary indica- 
tions that onest of Alzheimer’s might be tied to choles- 
terol levels. Although results must be confirmed by other 
scientists, lowering cholesterol in the diet might help pre- 
vent onset of the disease. 



Bridges, Barbara J., Therapeutic Caregiving: A Practical 
Guide for Caregivers of Persons with Alzheimer’ s and 
Other Dementia Causing Diseases. BJB Publishing 16212 
Bothell Way S.E., Suite F171 Mill Creek, Washington 

Carrier, Louise, and Henry Brodaty. “Mood and Behaviour 
Management.” In Clinical Diagnosis and Management of 
Alzheimer’ s Disease. 2nd edition, edited by Serge Gauthi- 
er. London: Martin Dunitz, 1999. 

Larkin, Marilynn. When Someone You Love Has Alzheimer' s: 
What you must know, what you can do, what you should 
expect.. Dell, 1995. 

Luskin, Frederic M., Ellen M. DiNucci, Kathryn A. Newell, 
and William L. Haskell. “Complementary/Alternative 
Therapies in Select Populations: Elderly Persons." In 
Complementary! Alternative Medicine: An Evidence Based 
Approach. Edited by John W. Spencer and Joseph J. Ja- 
cobs. St. Louis: Mosby, 1999 

Mace, Nancy L., and Peter V. Rabins. The 36- Hour Day. The 
John Hopkins University Press, 1995. 


Gottlieb, Scott R.“NSAIDs Can Lower Risk of Alzheimer’s.” 
British Medical Journal 323 no. 7324 (December 1, 
2001): 1269. 


Mitka M.“PET and Memory Impairment.” JAMA, Journal of 
the American Medical Association 286 no. 16 (October 
24, 2001 ): 1961 . 

Ott, Brian R.. and Norma J. Owens. “Complementary and Al- 
ternative Medicines for Alzheimer’s Disease.” Journal of 
Geriatric Psychiatry and Neurology 1 1 (1998): 163- 173. 

“Alzheimer Chemical Engineers Suggest Alzheimer Onset Tied 
to Cholesterol.” Pain and Central Nervous System Week 
(December 24, 20011:3. 

Stephenson Joan. “Alzheimer Treatment Target?” JAMA, Jour- 
nal of the American Medical Association 286 no. 14 (Oc- 
tober 10, 2001):1704. 

“Wiser Now.” Better Directions. PO Box 35 Spencerville, MD 
20868.(800) 999-0795. 


Alzheimer’s Association. 919 North Michigan Ave., Suite 1000 
Chicago, IL 60611. (800) 272-3900 (312) 335-8882. http:// 

National Institute of Aging, Alzheimer's Education, and Refer- 
ral Center. (800) 438-4380. 


Alzheimer’s Disease Books and Videotapes. http://www.alzhei 

Belinda Rowland 
Teresa G. Odle 

Amblyopia see Lazy eye 
American elm see Slippery elm 
American skullcap see Skullcap 

Amino acids 


Amino acids are known as the building blocks of 
protein, and are defined as the group of nitrogen-contain- 
ing organic compounds composing the structure of pro- 
teins. They are essential to human metabolism, and to 
making the human body function properly for good 
health. Of the 28 amino acids known to exist, eight of 
them are considered “essential,” defined as those that can 
be obtained only through food. These essential amino 
acids are tryptophan, lysine, methionine, phenylalaine, 
threonine, valine, leucine, and isoleucine. The “non-es- 
sential” amino acids include arginine, tyrosine, glycine, 
serine, glutmamic acid, aspartic acid, taurine, cycstine, 
histidine, proline, alanine, and creatine, which is a com- 
bination of arginine, glycine, and methionine. 

The human body, minus water, is 75% amino acids. 
All of the neurotransmitters (proteins) but one are com- 


posed of amino acids; and 95% of hormones are amino 
acids. Amino acids are key to every human bodily func- 
tion with every chemical reaction that occurs. 

Amino acids occur naturally in certain foods, such as 
dairy products, meats, fish, poultry, nuts, legumes, and eggs. 
Those sources are considered more complete than vegetable 
protein, such as beans, peas, and grains, also considered a 
good — even if not complete — source of amino acids. 

Amino acids became popular as dietary supplements 
by the end of the twentieth century for various uses, in- 
cluding fitness training, weight loss, and certain chronic 
diseases. Claims exist in holistic medicine that indicate 
amino acid supplements taken in the proper dosage can 
aid also in fighting depression, allergies, heart disease, 
gastrointestinal problems, high cholesterol, muscle 
weakness, blood sugar problems, arthritis, insomnia, 
bipolar illness, epilepsy, chronic fatigue syndrome, 
autism, attention-deficit hyperactivity disorder 
(ADHD), and mental exhaustion. 


Amino acid therapy as a supplemental aid to a healthy 
diet joined the fitness craze in the United States by the end 
of the 1990s. According to author Brenda Adderly in Better 
Nutrition, in September of 1999, “The creation of new pro- 
tein from amino acids and the breaking down of existing 
protein into amino acids are ongoing processes in our bod- 
ies. If, for example, you are working out and developing 
certain muscles, amino acids come to the rescue with new 
protein to build muscle cells,” Adderly noted. “Similarly, 
when you eat a complete protein, such as meat or beans and 
rice, the body breaks down the amino acids in that food for 
later use.” Understanding the balance of amino acids in the 
body can be often the first clue to understanding why a per- 
son suffers many ailments, ranging from depression to 
upset stomach to obesity. Deficiencies in the proper bal- 
ance of amino acids is likely to occur in those with poor 
diets. Because stress, age, infection, and various other fac- 
tors including the amount of exercise a person does, can 
also affect the levels of amino acids, people with healthy, 
nutritious diets could also find that they also suffer deficien- 
cies. Adderly adds that, “Not only are the symptoms of 
amino acid deficiencies wide ranging, but there are no 
RDAs (recommended daily allowances) or other guidelines, 
to help us tell if we are least covering all the bases. Add to 
that the complicated matter of keeping track of all 28 some 
with names most of us have never even heard and the situa- 
tion begins to seem overwhelming.” 

Essential amino acids 

The amino acids, which are derived only from food and 
that the body cannot manufacture, perform various functions. 


Amino acids 

Amino acids 

• Tryptophan. This is considered a natural relaxant, 
helps alleviate insomnia; helps in the treatment of mi- 
graine headaches; helps reduce the risk of artery and 
heart spasms; and works with lysine to reduce choles- 
terol levels. 

• Lysine. Aids in proper absorption of calcium; helps 
form collagen for bone cartilage and connective tis- 
sues; aids in production of antibodies, hormones, and 
enzymes. Research has indicated it also might be effec- 
tive against herpes by creating the balance of nutrients 
that slows the growth of the virus causing it. A defi- 
ciency could result in fatigue, lack of concentration, ir- 
ritability, bloodshot eyes, retarded growth, hair loss, 
anemia, and reproductive problems. 

• Methionine. Properties include providing the primary 
source of sulfur that can prevent disorders of the hair, 
skin, and nails; lowers cholesterol by increasing the 
liver’s production of lecithin; reduces liver fat; protects 
kidneys; and promotes hair growth. 

• Phenylalaine. This serves the brain by producing nor- 
epinephrine, the chemical that is responsible for trans- 
mitting the signals between the nerve cells and the 
brain; can maintain alertness; reduces hunger pains; 
acts as an antidepressant; and improves memory. 

• Threonine. Makes up a substantial portion of the colla- 
gen, elastin, and enamel protein; serves the liver by pre- 
venting buildup; aids the digestive and intestinal tracts 
to function better; and acts as a trigger for metabolism. 

• Valine. Promotes mental energy; helps with muscle co- 
ordination; and serves as a natural tranquilizer. 

• Leucine. Works with isoleucine to provide for the man- 
ufacture of essential biochemical processes in the body 
that are used for energy, increasing the stimulants to the 
upper brain for greater mental alertness. 

Roles of certain non-essential amino acids 

• Glycine. Facilitates the release of oxygen for the 
cell-making process; key role in manufacturing of hor- 
mones and health of immune system. 

• Serine. Source of glucose storage by the liver and mus- 
cles; provides antibodies for immune system; synthe- 
sizes fatty acid sheath around nerve fibers. 

• Glutamic acid. Nature’s “brain food” that increases 
mental prowess; helps speed the healing of ulcers; aids 
in combatting fatigue. 

Creatine in the spotlight 

One of the most discussed amino acid supplements 

available on the market is creatine monohydrate. The body 

produces small amounts of creatine in the kidneys, liver, 


and pancreas, making it a non-essential acid. With most 
diets that include red meat or fish, also come a few grams 
of creatine. It is stored in muscle cells and is used in activ- 
ities, such as weight lifting and sprinting, providing the 
necessary thrust of energy for such activities. But the nat- 
ural supply of creatine produced by the body is quickly 
depleted. After approximately 10 seconds, when muscle 
fatigue becomes apparent, the daily production is used. 

According to Timothy Gower, writing for Esquire in 
February of 1998, “Scientists identified creatine 160- 
odd years ago, but only in the 1980s did they figure out 
that muscle cells can be ‘loaded’ with up to 30% more of 
the compound than they normally carry. Since then, sev- 
eral studies have shown that weight lifters primed on the 
supplement tire less easily, allowing them to work out 
longer.” Gower also noted that creatine users find that 
the weight they add on is fat-free, whether that is lean 
tissue or some is water weight, no one has yet deter- 
mined, since muscle cells do fill with water during crea- 
tine loading. Additionally, while it can add to the burst of 
the energy a sprinter needs to perform well, creatine 
does not do anything for the marathon runner going for 
several hours. 

Commercially available since 1993, the long-term 
effects still remain unknown. One 2002 study did show 
that creatine use improved rehabilitation for injured ath- 
letes and another has shown that using the supplement 
does not increase risk of injury. It should be noted that 
some 20-30% of people researched showed no improve- 
ment using creatine. One early report indicated that crea- 
tine could be beneficial for some people in spurring me- 
tabolism, burning calories and helping in weight loss. 
Those reports were as yet inconclusive. 

General use 

Amino acid supplements to a healthy diet are used 
for various purposes. The most common uses include: 
sustaining strength in weight training to build muscles; 
improving heart and circulatory problems or diseases, 
particularly in the aging; the treatment of chronic fatigue 
syndrome; treating depression and anxiety; treating eat- 
ing disorders, such as bulimia and/or anorexia, along 
with overeating; increasing memory; building up and 
sustaining the body’s immune system in fighting bacteria 
and viruses. It is important to note that, while the neces- 
sity and role of all amino acids has been verified in the 
maintenance of optimum health, research is not exten- 
sive enough to provide indisputable verification of the 
touted benefits of such supplements over the long term. 

Nonetheless, some members of the scientific med- 
ical community would seem to confirm what amino acid 
proponents have long believed to be true. One such study 


from the Journal of the American College of Cardiology 
brought good news for the millions suffering from 
chronic heart failure. Dr. Rainer Hambrecht and col- 
leagues from the University of Leipzig, (Germany) test- 
ed the amino acid L-arginine on 38 heart-failure patients. 
Knowing that the human body converted it into nitric 
oxide, a chemical that relaxes blood vessels, the re- 
searchers gave one group 8 g of it daily for four weeks; 
another group simply did forearm exercises; and a third 
group combined the supplement with the exercise. The 
people who took the supplement alone increased their 
blood-vessel dilation by a factor of four, as did the exer- 
cise group. Those who took both the supplement and 
performed the exercise increased it by six. More recent 
studies on arginine in 2002 found that the supplement 
may help reduce risk of postoperative infections. Fur- 
ther, arginine may enhance women’s sexual function. 

Supplements are recommended by alternative med- 
ical practitioners particularly for those who are not get- 
ting a proper diet, especially vegetarians who might not 
be getting a balance of complete protein, as well as ath- 
letes, anyone under severe stress, and anyone whose al- 
cohol intake level is moderate to high. 


Supplements of various amino acids are available 
primarily in capsule, tablet, or powder form. A common 
way of taking amino acids is in a “multiple” amino acid 
gel cap. These contain sources of protein from gelatin, 
soy, and whey. The market for supplements in wholesale, 
retail, and internet sales was estimated to reach into the 
millions of dollars, with literally hundreds available. In- 
ternet sales were a fast-growing area particularly with 
the use of such supplements as creatine powder publi- 
cized by well-known Olympic stars and professional ath- 
letes. Daily usage of creatine as evident from research 
indicated that usage should be leveled at 5 g of powder 
in a glass of orange juice, and could be taken up to four 
times a day during peak athletic training. Maintenance 
dosages were recommended at 5 g once a day. 

Side effects 

Because amino acids are naturally produced sub- 
stances both in the human body and in the protein de- 
rived from animal and dairy products, as well as being 
present in food combinations such as beans and rice, 
such supplements are not regulated by the United States 
Food and Drug Administration (FDA), nor are there any 
specified daily requirements, and they also do not show 
up in either drug or urine tests. Amino acid supplements 
might be classified as having no affect at all. Long-term 
effects were not yet evident, however, due to the relative- 
ly recent phenomenon of use. 



Essential amino acids — Eight of the 28 amino 
acids known to exist are termed essential for 
adults, that are available only through food. 
Non-essential amino acids — The remaining amino 
acids that are produced in the human body. 


Interactions of amino acids with drugs has not been 

sufficiently studied to determine yet if any adverse ef- 
fects result from using amino acids with medications. 



Adderly, Brenda. “Amino Acids.” Better Nutrition (September 
1999). Available from 

“Amino acid screening.” Everything You Need to Know about 
Medical Tests, Annual. Springhouse Corporation: 1996. 
Available from 

Antinoro, Linda. “Food and Herbs That Keep Blood Moving, 
Prevent Circulatory Problems.” Environmental Nutrition 
(February 2000). 

“Arginine Seems to Benefit Both Immune and Sexual Re- 
sponse.” RN (February 2002): 22. 

Austin Nutritional Research. “Amino acids.” Reference Guide 
for Amino Acids. 2000. Available from http://www.realtime. 

Body Trends Fitness Products. "Amino acids.” 
commercial website. (2000). Available from http://www 

“Creatine Supplementation Speeds Rehabilitation.” Health and 
Medicine Week (January 21, 2002): 6. 

Davidson, Tish. “Amino acid disorders screening.” Gale Ency- 
clopedia of Medicine. Edition 1. Detroit: 1999. Available 

Dolby, Victoria. “Anxiety? Send herbs, 5-HTP, and amino 
acids to the rescue!” Better Nutrition (June 1998). Avail- 
able from 

Gersten, Dennis J., M.D. “Amino Acids: Building Blocks of 
Life, Building Blocks of Healing.” The Gersten Institute 
for Integrative Medicine. (2000). Available from http:// 

Gower, Timothy. “Eat Powder! Build Muscle! Burn Calories!” 
Esquire (February 1998). Available from http://www. 

Moyano, D.; Vilaseca, M.AA.; Artuch, R.; and, Lambruschini, 
N. “Plasma Amino Acids in Anorexia Nervosa.” Nutrition 
Research Newsletter (November 1998). Available from 

"Studies Say Creatine is OK.” Obesity, Fitness & Wellness 
Week (January 12, 2002): 12. 


Amino acids 


Toews, Victoria Dolby. “6 Amino Acids Unleash the Energy.” 
Better Nutrition (June 1999). Available from http://web2. 

Totheroh, Gailon. "Amino Acid Therapy Pays Off.” Christian 
Broadcasting Network (10 May 1999). Available from 

Tuttle, Dave. “Muscle’s little helper.” Men's Fitness (December 
1998). Available from 

Wernerman, Jan. “Documentation of clinical benefit of specific 
amino acid nutrients.” The Lancet (5 September 1998). 
Available from 

Williams, Stephen. “Passing the Acid Test.” Newsweek (27 
March 2000). 

Jane Spehar 
Teresa G. Odle 

Amyotrophic lateral sclerosis see Lou 

Gehrig's disease 

An-mo see Chinese massage 



Andrographis is the herb of Andrographis panicula- 
ta , a flowering plant in the Acanthaceae family. The 
perennial grows wild in thickets throughout south Asia, 
although it also may be cultivated. In summer and au- 
tumn, clusters of small white flowers appear; it is har- 
vested when the flowers begin to bloom. It is traditional- 
ly valued as an herbal remedy in China, where it grows 
in the Guangdong, Guangxi, Fujian, Yunnan, Sichuan, 
Jiangsu, and Jianxi provinces. 

In Mandarin, andrographis is called chuan xin lian, 
Yi jian xi and Lan he lian, which translate directly as 
“thread-the-heart lotus.” The Cantonese term is chyun 
sam ling, and the Japanese call it senshinren. English 
common names include green chiretta, heart-thread lotus 
leaf, and kariyat. Its pharmaceutical names, used to dis- 
tinguish it as a medicine, are Herba Andrographitis Pan- 
iculatae or alternately Folium Andrographis. 

General use 

Practitioners of Chinese medicine believe that andro- 
graphis affects the large intestine, lung, stomach, bladder, 
and liver meridians, or energy pathways in the body. It is 
thought to dispel heat (such as that associated with fever 
or infection) and is used primarily as a broad-spectrum 
antibiotic and immunostimulant for a variety of bacterial, 
viral, and parasitic conditions, including influenza, in- 
testinal infections, hepatitis, pneumonia, and infected 


wounds. Andrographis ’s medicinal properties are consid- 
ered very bitter, astringent, cold, dry, and stimulating. 

Andrographis is considered most effective for con- 
ditions associated with fever, inflammation, and the for- 
mation of pus. It clears heat and relieves “fire toxicity” 
manifest as sores and carbuncles on the skin. It is also 
applied topically for snakebite and eczema. Under the 
supervision of a qualified practitioner, it is used as a 
uterine stimulant and abortive, to bring on miscarriage or 
treat prolonged pregnancy or retained placenta. 

Andrographis can also be used as an inexpensive 
substitute for another Chinese herb, coptis ( huang lian). 

Research on andrographis has generally been conduct- 
ed in China and has focused on pharmacological investiga- 
tion. Studies indicate that andrographis cultivated in the 
plains of Shanghai has significant immune stimulating and 
anti-infective qualities. In vitro, it inhibits the growth of 
Diplococcus pneumoniae and other bacteria and delays the 
deterioration of embryonic renal cells caused by a virus. 

Major chemical ingredients include andrographan, 
andrographolide, neoandrographolide, paniculide A, 14- 
deoxy-1 1-oxyandrographolide, and beta-sitosterol. 


Andrographis is not generally available in American 
health food stores, but it can be found at most Chinese 
pharmacies and Asian groceries. 

The standard dose ranges from 10-15 grams as a de- 
coction (strong tea) or 2-5 milliliters as a tincture. Pow- 
der doses range from 0.6 to 1.2 grams. Because the herb 
is extremely bitter, it’s recommended that powder be 
taken in capsule form. 

Practitioners of Chinese medicine commonly com- 
bine andrographis in patent formulas along with other 
Chinese herbs. The following are the major herbs with 
which it is combined and the symptoms for which the 
combinations are prescribed. 

• Pericarpium Citri Reticulatae (Citrus reticulata, Chen 
pi) for cough associated with Lung heat. 

• Herba et Radix Houttuyniae Cordatae ( Houttuynia 
cordata, yu xing cao) and Semen Benincasae Hispidae 
(Benincasa hispida, dong gua ren cao ) for Lung 

• Flos Lonicerae Japonicae ( Lonicera japonica, jin yin 
hua) and Radix Platycodonis Grandiflori ( Platycodon 
grandiflorum, jie geng) for early stages of a disease 
with fever and sore throat. 

• Herba Portulacae Oleraceae (Portulacca oleracea, ma 
chi xian ) for dysentery. 

• Radix et folium Polygoni Cuspidati (Polygonum cuspi- 
datum, hu zhang) and Rhizoma Imperatae Cylindricae 



Cold — In Chinese pathology, the term defines a 
condition that has insufficient warmth, either ob- 
jective (hypothermia) or subjective (feeling cold). 

Decoction — A strong tea brewed for 20-30 min- 

Heat — In Chinese pathology, the term defines a 
condition that has excessive heat, either objective 
(fever, infection) or subjective (feeling hot). 

Meridians — Energetic pathways inside the body 
through which Qi flows; also called channels. 

Patent formulas — Chinese herbal formulas that 
were patented centuries ago and are believed to 
be proven over centuries of use and study. 

Tincture — A solution of medicinal substance in al- 
cohol, usually more or less diluted. Herb tinctures 
are made by infusing the alcohol with plant mate- 

Qi — A Chinese medical term denoting active 
physiological energy. 

( Imperata cylindrical var. major , bai mao gen) for hot, 
painful urinary disfunction. 


According to tradition, andrographis is never used in 
cases of deficient, cold intestinal conditions. When used 
long-term or in large doses, this bitter and cold herb may 
damage stomach qi, causing gastric distress and loss of 

Andrographis is also capable of producing a miscar- 
riage, and thus should be avoided by pregnant women un- 
less otherwise directed by a knowledgeable practitioner. 

Side effects 

Gastric distress and loss of appetite have been noted 
when the herb is taken in large doses. 


No interactions with pharmaceutical drugs have 
been noted. 



Bensky, D. and Gamble, Andrew. Chinese Herbal Medicine: 
Materia Medica. Revised ed. Eastland Press, 1993. 


Fan, W. A Manual of Chinese Herbal Medicine: Principles and 
Practice for Easy Reference. Shambala, 1996. 

Holmes. P. Jade Remedies: A Chinese Herbal Reference for the 
West. Snow Lotus Press, 1996. 

Hsu, Hong- Yen, et. al. Oriental Materia Medica: A Concise 
Guide. Oriental Healing Arts Institute, 1986. 

Erika Lenz 



Androstenedione is a hormone that occurs naturally 
in the body, and is one of those responsible for male 
characteristics. It is a metabolite of DHEA, and as such, 
a direct precursor to the male hormone testosterone. It is 
found in some plant matter, notably pollen, and in the 
gonads of all mammals. 

General use 

Supplementation with androstenedione increases 
blood levels of testosterone, which among other things, 
will lead to an increase in strength and muscle mass. As 
such, it is mainly of interest to athletes and bodybuilders, 
for whom it has the added benefits of increasing energy 
levels, improving levels of nitrogen retention and shorten- 
ing muscle recovery time. Androstenedione is safer than 
anabolic steroids because it has a far gentler effect on the 
body, and potential effects are milder and more transient. 

Androstenedione is also taken to improve well 
being, and to raise levels of mental alertness. In addition, 
it is thought to have a positive effect on sexual perfor- 
mance. As androstenedione also aids in the conversion of 
fatty tissue to muscle, it could conceivably be considered 
an aid to weight loss. 

The German patent for androstenedione states that 50 
mg administered orally raised testosterone levels from 
140-183% above normal, which although impressive, is 
considerably less than the increase associated with adminis- 
tration of anabolic steroids. Also, it is a precursor, in that the 
body retains some control over production of testosterone. 


When taken orally, androstenedione is metabolized 
by a single enzyme into testosterone. Athletes generally 
take between 50-300 mg daily, according to how much 
time is spent exercising and how much physical im- 
provement is required. Dosage is usually sublingual in 
the form of a spray or capsules. The spray is felt to be far 




more effective, due to imperfect absorption through the 
digestive route. 

Levels of testosterone in the blood will begin to rise 
approximately 15 minutes after administration of an- 
drostenedione supplements. They will remain so for 
about three hours, with testosterone levels peaking 
roughly 1—1.5 hours after administration. 


There is, as of July 2000, no reliable research to prove 
the claims by supplement companies that androstenedione 
is useful. Trials that have been conducted are limited in 
size and scope, and generally do not satisfy the criteria set 
for medical trials. Some experts warn that as a result of the 
short time that androstenedione stays in the system, it is 
unlikely to have any significant bodybuilding effects. 

Androstenedione is not suitable for pregnant or lactat- 
ing women, and should not be taken at all by children. 
When taken by women, this supplement may cause hir- 
suitism and virilization. Caution should be exercised when 
males under the age of 25 years take androstenedione. 

Those supplementing with androstenedione on a 
regular basis are advised to have “cool down” periods 
when the product is not taken. This can either be a cou- 
ple of days a week, or one week per month. 

Androstenedione is unsuitable for use by men with 
prostate cancer or elevated PSA. It may also stimulate 
prostate replication, enlarging the prostrate (benign 
prostate hypertrophy or cancer). Many experts are skep- 
tical of the claims made by supplement companies, be- 
cause they say that natural bodily checks and balances 
will work against this supplement to ensure that muscle 
mass and strength do not exceed normal levels for the in- 
dividual. Taking androstenedione at times other than pe- 
riods of physical exertion is not recommended, because 
of the possible effect on mood. 

Because of the complex interaction of hormones 
within the body, it is strongly advised that anyone con- 
templating supplementing with androstenedione consult 
a qualified practitioner. 

Whereas anabolic steroids are illegal, androstene- 
dione is considered a dietary supplement, and as such is 
not governed by the same regulations. 

As a result of trials conducted by them, the American 
Medical Association issued a statement to the effect that 
androstenedione does not raise serum testosterone levels, 
and in addition, it may have undesirable side effects. 

Side effects 

Possible effects on the personality of this type of 
hormone should be considered, as high levels of male 



Anabolic steroids — Synthetic male hormones. 
DHEA — Dehydroepiandrosterone, which is basi- 
cally a male hormone. 

Hirsuitism — The growth of excess hair on the 
bodies of women, usually due to a hormone im- 

PSA — Prostatic Specific Antigen, elevated levels of 
which are a precondition to the development of 
cancer of the prostate gland. 

Sublingual — Taken underneath the tongue. 
Transient — Of short duration. 

Virilization — The development of male character- 
istics in women. 

hormones have been known to trigger aggressive behav- 
ior in some cases, particularly when high doses of the 
supplement are involved. 

It is also possible that long-term use of androstene- 
dione, which is not in accordance with medical recom- 
mendations, may eventually have a negative effect on nat- 
ural levels of testosterone, due to compensation on the 
part of the pituitary gland. This means that, in the long 
term, it is possible that supplementation with androstene- 
dione may cause a reduction in levels of testosterone. 

The androgen effect of androstenedione may cause 
males to develop loss of head hair. Other side effects that 
have been associated with androstenedione administra- 
tion include blurred vision, development of breast-like 
tissue, and the development of acne. 


This supplement should not be taken in conjunction 
with other bodybuilding substances, particularly anabol- 
ic steroids, unless under the direction of a physician. 
Lysophosphatidyl choline, when taken in conjunction 
with androstenedione, may enhance absorption. 

In addition, manufacturers recommend saw palmet- 
to to be taken in conjunction with androstenedione as it 
can help reduce associated hair loss, and is useful in 
controlling prostate enlargement. 



Betterbodz (1995-2000). [cited December 28, 2000], <http:// edione.html/> 

GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 (1998-2000). [cited December 28, 
2000], <> 

Patricia Skinner 



Anemarrhena ( Anemarrhena asphodeloides or Zhi 
Mu) is a rare herb that grows wild in Japan and the 
northern part of China. It has a 2,000-year history of use, 
and written records of its use date from 200 a.d. It is an 
attractive-looking plant that belongs to the lily family. At 
the top of three-foot spikes, it has small, fragrant, white 
six-petaled flowers that bloom at night. The medicinal 
parts are the rhizomes (roots) and the stems. Rhizomes 
that are large, hard, and round with pale-yellowish color 
inside are best for medicinal use. 

General use 

Traditional Chinese medicine classifies this herb 
as cold (or yin) and bitter. Yin and yang are the two op- 
posite energies that complement one another. Yin condi- 
tions are described as cold, damp, and deficient, while 
yang is characterized by heat, dry, and excess. Anemar- 
rhena is used to treat heat disorders, which are caused by 
excessive yang or insufficient yin functions. When there 
is excessive heat, dryness often follows. For example, 
fever — an excessive internal heat symptom — is followed 
by thirst, which is a sign of dryness. Traditional Chinese 
medicine uses bitter and cold herbs such as anemarrhena 
to clear the internal heat and provide moisture to the 
lungs and the kidneys. 

Because anemarrhena brings moisture and coolness, 
it will bring relief to excessive internal heat and dryness 
symptoms such as fever, thirst, irritability, racing pulse, 
cough, bleeding gums, night sweat, insomnia, and hot 
flashes. Anemarrhena has been used in herbal combina- 
tions such as Zhi Bai Di Huang Wan to relieve symptoms 
such as coughing, ulcers of the mouth, kidney dysfunc- 
tion, urinary tract infection, insomnia, restlessness, geni- 
tal herpes, and sterility. 

Chronic bronchitis 

Laboratory studies have shown that anemarrhena 
can effectively eradicate infections caused by Staphylo- 
coccus aureus, the bacterial strain that often causes lung 
infections. Anemarrhena has been effectively used to 


treat bronchitis as well as exacerbating symptoms of 
chronic bronchitis such as chronic coughing. 


Anemarrhena is also used to treat tuberculosis. 
Here, however, laboratory results do not support its use. 
When given as 2.5% powder, anemarrhena may slow 
down disease progression, but overall it does not reduce 
death rates in laboratory mice. At higher dosage (5% 
powder), anemarrhena appears to be toxic. More mice 
treated with anemarrhena died than in the control group. 
Therefore, even though the herb can effectively reduce 
the low-grade fever associated with tuberculosis, it is a 
poor substitute for conventional antibiotics, which can 
cure the disease and prevent death. 

Urinary tract infections 

Anemarrhena has been used to treat cystitis, an in- 
fection of the bladder. Studies have shown that it is ef- 
fective against Escherichia coli, which commonly causes 
cystitis in women. Therefore, it may be effective against 
urinary tract infections caused by this bacterial strain. 

Other infections 

There is little information available concerning the 
use of anemarrhena in other types of infections. Howev- 
er, laboratory studies show that anemarrhena has an- 
tibacterial activity against Salmonella typhi and Vibrio 
cholera, the bacteria that cause salmonella food poison- 
ing and cholera, two common infections of the bowels. 
Studies also show that anemarrhena may also be effec- 
tive against fungal infections. 


Anemarrhena provides moisture to dry internal or- 
gans. Therefore, it is often used as diuretic to improve 
kidney function. 

Ulcers of the mouth and/or bleeding gums 

Anemarrhena can restore moisture in these oral con- 
ditions that exhibit excessive dryness and inflammation. 


Because Chinese herbalists believe that yin deficien- 
cy is the underlying cause of diabetes, they often use ane- 
marrhena to treat this disease. In fact, there is scientific ev- 
idence to support its use in the treatment of diabetes. Ani- 
mal studies show that anemarrhena contains two pharma- 
cologic agents, mangiferin and mangiferin-7-0-beta 
glucoside, which appear to increase the effectiveness of 
insulin and can lower blood glucose levels. Anemarrhena 




has the greatest effect in mild to moderate diabetic condi- 
tions. However, it does not affect glucose levels in nondia- 
betic conditions. Anemarrhena may be combined with Shi 
Gao (Gypsum) for additional hypoglycemic effects. 

Chemotherapy and radiation side effects 

Anemarrhena is often effective in relieving severe 
adverse reactions associated with conventional 
chemotherapy and radiation treatments in cancer pa- 
tients. According to traditional Chinese medicine, x rays 
used in radiation treatment and drugs used in chemother- 
apy are considered “heat toxins.” These agents are very 
toxic so that they can kill tumor cells. But they are also 
toxic to the body, causing excessive build-up of heat in- 
side the Lungs and damaging the Kidneys. 

Menopausal symptoms 

Another use of anemarrhena is to treat menopausal 
symptoms such as insomnia, hot flashes, and irregular 

High blood pressure 

Anemarrhena is often used in combination with 
phellodendron and rehmannia to treat high blood pres- 
sure conditions in patients with symptoms of Liver-fire 
deficiency (dizziness, headache, ringing in the ears, 
back pain, insomnia, palpitations, dry eyes, and night 
sweat). Recent studies in laboratory animals confirm that 
this herb is effective in lowering blood pressure. 


The usual dosage of anamarrhena is 6-12 g per day. 
It is available as a single ingredient or in combinations in 
the following forms: 

• Powder or pills. Should be taken with warm water on 
an empty stomach. 

• Decoction. A method often used in traditional Chinese 
medicine to make an herbal preparation at home. Herbs, 
usually in combination, are simply boiled down to a con- 
centrated broth or tea to be taken internally. 


Anemarrhena should not be used under the follow- 
ing conditions: 

• watery diarrhea 

• chronic loose bowel movements 

• hypotension (low blood pressure). (Anemarrhena at 
very high dosages can cause severe drops in blood 
pressure levels) 


Side effects 

Animal studies show that anemarrhena, when ad- 
ministered intravenously at only moderate dosage, can 
cause breathing difficulty and a decrease in blood pres- 
sure. High dosages reportedly can cause a severe drop in 
blood pressure, respiratory arrest, and even death. 


Anemarrhena has been known to interact with: 

• Iron supplements or multivitamin, multimineral sup- 
plements containing iron. Therefore, patients should 
take iron supplements at least two hours before or two 
hours after the herb. 

• Iron pots or pans. Patients should not use iron cooking 
utensils to make decoctions as they may alter the chem- 
istry of the herb. 



Bensky, Dan, and Andrew Gamble, Chinese Herbal Medicine: 
Materia Medica. Rev. ed. Seattle: Eastland Press, 1993. 
Molony, David. The American Association of Oriental Medi- 
cine’s Complete Guide to Chinese Herbal Medicine. New 
York: Philip Lief Group, 1998. 


Ichiki H., et al. “New Antidiabetic Compounds, Mangiferin 
and Its Glucosides.” Biol Pharm Bull. 21 no. 12 (1998): 

Iida Y., et al. “Detection of Antifungal Activity in Anemarrhena 
Asphodeloides in Sensitivity BCT Method and Isolation 
of Its Active Compounds.” Journal ofAgric Food Chem. 
Al no. 2 (Feb 1999): 584-587. 


American Association of Oriental Medicine (AAOM). 433 
Front St., Catasauqua, PA 18032. (610) 266-1433. Fax: 
(610) 264-2768. E-mail: <http://www. > 

American Foundation of Traditional Chinese Medicine. 505 
Beach Street, San Francisco, CA 94133. (415) 776-0502. 
American Herbal Products Association. 8484 Georgia Ave., 
Suite 370, Silver Spring, MD 20910. (301) 588-1174. 

National Center for Complementary and Alternative Medicine; 
National Institute of Health. NCCAM Clearinghouse, PO 
Box 8218, Silver Spring, MD 20907-8218. (888) 644- 
6226. Fax: (301) 495-4957. E-mail: nccam-info@nccam. <> 


Choate, Clinton J. “Diabetes: Modern Medicine and Tradition- 
al Chinese Medicine-Part Three." 



Diuretic — A substance that increases the forma- 
tion and excretion of urine. 

Energy — Includes nonmaterial (eg, Qi) as well as 
material (eg, blood) vital forces that create and 
sustain life. 

Fire — An extremely high internal heat condition 
characterized by severe dehydration, red eyes, red 
face, constipation, insomnia, and agitation. Fire 
often affects Lungs, Liver, and Stomach. 

Oliguria — A condition in which the kidneys pro- 
duce small amounts of urine. 

Greacen, “Molly” Amelia. “The Use of Chinese Herbs and 
Other Natural Modalities as Alternatives to Hormone Re- 
placement Therapy.” Spanda Medical Company. <http://> 

Rosenberg, Z'ev. “Treating the Undesirable Effects of Radiation 
and Chemotherapy with Chinese Medicine.” HealingPeo- < 
1999/12/10/1 13.tmpL> 

Mai Tran 



Anemia is a condition characterized by abnormally 
low levels of healthy red blood cells or hemoglobin. 


The tissues of the human body need a regular supply of 
oxygen to stay healthy. Red blood cells, which contain hemo- 
globin that allows them to deliver oxygen throughout the 
body, live for only about 120 days. When they die, the iron 
they contain is returned to the bone marrow and used to cre- 
ate new red blood cells. Anemia can develop when heavy 
bleeding causes significant iron loss. It also occurs when 
something happens to slow down the production of red blood 
cells or to increase the rate at which they are destroyed. 

Anemia can be mild, moderate, or severe enough to 
lead to life-threatening complications. Over 400 different 
types of anemia have been identified. Many of them are 
rare. More common anemia types include: 


• iron deficiency anemia 

• folic acid deficiency anemia 

• vitamin B 12 deficiency anemia 

• vitamin C deficiency anemia 

• autoimmune hemolytic anemia 

• hemolytic anemia 

• sickle cell anemia 

• aplastic anemia 

• anemia of chronic disease 

Causes & symptoms 

Anemia is caused by bleeding, decreased red blood 
cell production, or increased red blood cell destruction. 
Poor diet can contribute to vitamin deficiency and iron 
deficiency anemia, in which fewer red blood cells are 
produced. Hereditary disorders and certain diseases can 
cause increased blood cell destruction. However, exces- 
sive bleeding is the most common cause of anemia, and 
the speed with which blood loss occurs has a significant 
effect on the severity of symptoms. Chronic blood loss 
may be caused by: 

• heavy menstrual flow 

• hemorrhoids 

• nosebleeds 

• cancer 

• gastrointestinal tumors 

• diverticulosis 

• polyposis 

• stomach ulcers 

• long-term alcohol abuse 

Acute blood loss is usually the result of: 

• childbirth 

• injury 

• ruptured blood vessel 

• surgery 

Iron deficiency anemia 

Iron deficiency anemia is the most common form of 
anemia in the world. In the United States, iron deficiency 
anemia affects about 240,000 toddlers between one and 
two years of age and 3.3 million women of childbearing 
age. This condition is less common in older children and 
in adults over 50, and it rarely occurs in teenage boys 
and young men. 




This illustration shows the microscope view of normal red 
blood cells (left) and those in three different types of ane- 
mia (from left), iron-deficiency anemia, megaloblastic ane- 
mia, and sickle cell anemia. (Photograph by John Bavosi, 
Custom Medical Stock Photo. Reproduced by permission.) 

The onset of iron deficiency anemia is gradual. The 
deficiency begins when the body loses more iron than it 
gains from food and other sources. Because depleted 
iron stores cannot meet the red blood cells’ needs, fewer 
red blood cells develop. In this early stage of anemia, the 
red blood cells look normal, but they are reduced in 
number. Then the body tries to compensate for the iron 
deficiency by producing more red blood cells, which are 
characteristically small in size. 

Weakness, fatigue, and a run-down feeling may be 
signs of mild anemia. Other signs include skin that is 
pasty or sallow, or lack of color in the creases of the 
palm, gums, nail beds, or lining of the eyelids. Someone 
who is weak, tires easily, is often out of breath, and feels 
faint or dizzy may be severely anemic. Other symptoms 
of anemia are: 

• angina pectoris (chest pain) 


• headache 

• inability to concentrate and/or memory loss 

• inflammation of the mouth (stomatitis) or tongue (glos- 

• insomnia 

• irregular heartbeat 

• loss of appetite 

• nails that are dry, brittle, or ridged 

• rapid breathing 

• sores in the mouth, throat, or rectum 

• sweating 

• swelling of the hands and feet 

• thirst 

• tinnitus (ringing in the ears) 

• unexplained bleeding or bruising 

• pica (a craving to chew ice, paint, or dirt) 

Folic acid deficiency anemia 

Folic acid deficiency anemia is the most common 
type of megaloblastic anemia, in which red blood cells 
are bigger than normal. It is caused by a deficiency of 
folic acid, a vitamin that the body needs to produce nor- 
mal cells. 

Folic acid anemia is especially common in infants 
and teenagers. Although this condition usually results 
from a dietary deficiency, it is sometimes due to an in- 
ability to absorb enough folic acid from foods such as: 


• fish 

• green vegetables 

• meat 

• milk and cheese 

• mushrooms 

• yeast 

Smoking raises the risk of developing this condition 
by interfering with the absorption of vitamin C, which the 
body needs to absorb folic acid. Folic acid anemia can be 
a complication of pregnancy, when a woman’s body 
needs eight times more folic acid than it does otherwise. 

Vitamin B n deficiency anemia 

Less common in this country than folic acid anemia, 
vitamin B 12 deficiency anemia is another type of mega- 
loblastic anemia that develops when the body does not 


absorb enough of this nutrient. Necessary for the creation 
of red blood cells, B 12 is found in meat and vegetables. 

Large amounts of B 12 are stored in the body, so this 
condition may not become apparent until as long as four 
years after B 12 absorption slows down or stops. The re- 
sulting drop in red blood cell production can cause: 

• loss of muscle control 

• loss of sensation in the legs, hands, and feet 

• soreness or burning of the tongue 

• weight loss 

• yellow-blue color blindness 

The most common form of B 12 deficiency is perni- 
cious anemia. Since most people who eat meat or eggs 
get enough B 12 in their diets, a deficiency of this vitamin 
usually means that the body is not absorbing it properly. 
This can occur among people who have had intestinal 
surgery or those who do not produce adequate amounts 
of intrinsic factor, a chemical secreted by the stomach 
lining that combines with B 12 to help its absorption in the 
small intestine. Symptoms of pernicious anemia include 
problems with movement or balance, a slick tongue, tin- 
gling in the hands and feet, confusion, depression, and 
memory loss. Pernicious anemia can also damage the 
spinal cord. A doctor should be notified whenever symp- 
toms of this condition occur. 

Pernicious anemia usually strikes people 50-60 years 
of age. Eating disorders or an unbalanced diet increases 
the risk of developing pernicious anemia. So do diabetes 
mellitus, gastritis, stomach cancer, stomach surgery, thy- 
roid disease, and family history of pernicious anemia. 

Vitamin C deficiency anemia 

A rare disorder that causes the bone marrow to man- 
ufacture abnormally small red blood cells, vitamin C de- 
ficiency anemia results from a severe, long-standing di- 
etary deficiency. 

Hemolytic anemia 

Some people are born with hemolytic anemia. Some 
acquire this condition, in which infection or antibodies 
destroy red blood cells more rapidly than bone marrow 
can replace them. 

Hemolytic anemia can enlarge the spleen and accel- 
erate the destruction of red blood cells (hemolysis). Other 
complications of hemolytic anemia may include pain, 
shock, gallstones, and other serious health problems. 


An inherited form of hemolytic anemia, thalassemia 
stems from the body’s inability to manufacture as much 


normal hemoglobin as it needs. There are two categories 
of thalassemia, depending on which of the amino acid 
chains is affected. (Hemoglobin is composed of four 
chains of amino acids.) In alpha-thalassemia, there is an 
imbalance in the production of the alpha chain of amino 
acids; in beta-thalassemia, there is an imbalance in the 
beta chain. Alpha-thalassemias most commonly affect 
blacks (25% have at least one gene); beta-thalassemias 
most commonly affect people of Mediterranean and 
Southeast Asian ancestry. 

Characterized by production of red blood cells that 
are unusually small and fragile, thalassemia only affects 
people who inherit the gene for it from each parent (au- 
tosomal recessive inheritance). 

Autoimmune hemolytic anemia 

Warm antibody hemolytic anemia is the most com- 
mon type of this disorder. This condition occurs when 
the body produces autoantibodies that coat red blood 
cells. The coated cells are destroyed by the spleen, liver, 
or bone marrow. 

Warm antibody hemolytic anemia is more common 
in women than in men. About one-third of patients who 
have warm antibody hemolytic anemia also have lym- 
phoma, leukemia, lupus, or connective tissue disease. 

In cold antibody hemolytic anemia, the body attacks 
red blood cells at or below normal body temperature. 
The acute form of this condition frequently develops in 
people who have had pneumonia, mononucleosis, or 
other acute infections. It tends to be mild and short- 
lived, and disappears without treatment. 

Chronic cold antibody hemolytic anemia is most 
common in women and most often affects those who are 
over 40 and have arthritis. This condition usually lasts 
for a lifetime, generally causing few symptoms. Howev- 
er, exposure to cold temperatures can accelerate red 
blood cell destruction, causing fatigue, joint aches, and 
discoloration of the arms and hands. 

Sickle cell anemia 

Sickle cell anemia is a chronic, incurable condition 
that causes the body to produce defective hemoglobin, 
which forces red blood cells to assume an abnormal cres- 
cent shape. Unlike normal oval cells, fragile sickle cells 
cannot hold enough hemoglobin to nourish body tissues. 
The deformed shape makes it hard for sickle cells to pass 
through narrow blood vessels. When capillaries become 
obstructed, a life-threatening condition called sickle cell 
crisis is likely to occur. 

Sickle cell anemia is hereditary. It almost always af- 
fects people of African or Mediterranean descent. A 




child who inherits the sickle cell gene from each parent 
will have the disease, but a child who inherits the gene 
from only one parent will carry the sickle cell trait, but 
will not have the disease. 

Aplastic anemia 

Sometimes curable by bone marrow transplant, but 
potentially fatal, aplastic anemia is characterized by de- 
creased production of red and white blood cells and 
platelets (disc-shaped cells that allow the blood to clot). 
This disorder may be inherited or acquired as a result of 
recent severe illness, long-term exposure to industrial 
chemicals, or use of anticancer drugs and certain other 

Anemia of chronic disease 

Cancer, chronic infection or inflammation, and kid- 
ney and liver disease often cause mild or moderate ane- 
mia. Chronic liver failure generally produces the most 
severe symptoms. 


Personal and family health history may suggest the 
presence of certain types of anemia. Laboratory tests that 
measure the percentage of red blood cells or the amount 
of hemoglobin in the blood are used to confirm diagnosis 
and determine which type of anemia is responsible for a 
patient’s symptoms. X rays and examinations of bone 
marrow may be used to identify the source of bleeding. 


Anyone who has anemia caused by poor nutrition 
should modify his or her diet to include more vitamins, 
minerals, and iron. Foods such as lean red meats, dried 
beans and fruits, liver, poultry, and enriched breads and 
cereals are all good sources of iron. In addition, eating 
foods rich in vitamin C such as citrus fruits and juices 
can promote the absorption of iron. 

Patients diagnosed with iron-deficiency anemia 
should undergo a thorough physical examination and 
medical history to determine the cause of the anemia, 
particularly if chronic or acute blood loss is suspected. 
The cause of a specific anemia will determine the type of 
treatment recommended. 

Anemia due to nutritional deficiencies can usually 
be treated at home with iron supplements or self admin- 
istered injections of vitamin B 12 . People with folic acid 
anemia should take oral folic acid replacements. Vitamin 
C deficiency anemia can be cured by taking daily sup- 
plements of vitamin C. 


Many therapies for iron-deficiency anemia focus on 
adding iron-rich foods to the diet or on techniques to 
improve circulation and digestion. Iron supplementa- 
tion, especially with iron citrate (less likely to cause 
constipation), can be given in combination with herbs 
that are rich in iron. Some examples of iron-rich herbs 
are dandelion ( Taraxacum officinale ), parsley (Pet- 
roselinum crispum ), and nettle ( Urtica dioica). The 
homeopathic remedy ferrum phosphoricum (iron sul- 
fate) can also be helpful. 

An iron-rich herbal tonic can also be made using the 
following recipe: 

• Soak one-half ounce of yellow dock root and one-half 
ounce dandelion root in 1 qt of boiled water for 4-8 

• Simmer until the amount of liquid is reduced to 1 cup. 

• Remove from heat and add one-half cup black strap 
molasses, mixing well. 

• Store in refrigerator: take one-quarter cup daily. 

Other herbal remedies known to promote digestion 
are prescribed to treat iron-deficiency anemia. Gentian 
(■ Gentiana luted) is widely used in Europe to treat ane- 
mia and other nutritionally-based disorders. The bitter 
qualities of gentian help stimulate the digestive system, 
making iron and other nutrients more available for ab- 
sorption. This bitter herb can be brewed into tea or pur- 
chased as an alcoholic extract (tincture). 

Other herbs recommended to promote digestion in- 

• anise ( Pimpinella anisum) 

• caraway (Carum carvi ) 

• cumin ( Cuminum cyminum) 

• linden (Tilia spp.) 

• licorice ( Glycyrrhiza glabra) 

Traditional Chinese treatments for anemia include: 

• acupuncture to stimulate a weakened spleen 

• asian ginseng ( Panax ginseng) to restore energy 

• dong quai ( Angelica sinensis) to control heavy men- 
strual bleeding 

• a mixture of dong quai and Chinese foxglove ( Rehman - 
nia glutinosa) to clear a sallow complexion 

• astragalus ( Astragalus membranaceus) to treat pallor 
and dizziness 


Allopathic treatment 

Surgery may be necessary to treat anemia caused by 
excessive loss of blood. Transfusions of red blood cells 
may be used to accelerate production of red blood cells. 

Medication or surgery may also be necessary to con- 
trol heavy menstrual flow, repair a bleeding ulcer, or re- 
move polyps (growths or nodules) from the bowels. 

Patients with thalassemia usually do not require 
treatment. However people with a severe form may re- 
quire periodic hospitalization for blood transfusions 
and/or bone marrow transplantation. 

Sickle cell anemia 

Treatment for sickle cell anemia involves regular 
eye examinations, immunizations for pneumonia and in- 
fectious diseases, and prompt treatment for sickle cell 
crises and infections of any kind. Psychotherapy or 
counseling may help patients deal with the emotional 
impact of this condition. 

Vitamin B , 2 deficiency anemia 

A life-long regimen of B 12 shots is necessary to con- 
trol symptoms of pernicious anemia. The patient may be 
advised to limit physical activity until treatment restores 
strength and balance. 

Aplastic anemia 

People who have aplastic anemia are especially sus- 
ceptible to infection. Treatment for aplastic anemia may 
involve blood transfusions and bone marrow transplant 
to replace malfunctioning cells with healthy ones. 

Anemia of chronic disease 

There is no specific treatment for anemia associated 
with chronic disease, but treating the underlying illness 
may alleviate this condition. This type of anemia rarely 
becomes severe. If it does, transfusions or hormone treat- 
ments to stimulate red blood cell production may be pre- 

Hemolytic anemia 

There is no specific treatment for cold-antibody he- 
molytic anemia. About one-third of patients with warm- 
antibody hemolytic anemia respond well to large doses 
of intravenous and oral corticosteroids, which are gradu- 
ally discontinued as the patient’s condition improves. Pa- 
tients with this condition who do not respond to medical 
therapy must have the spleen surgically removed. This 
operation controls anemia in about half of the patients on 
whom it is performed. Immune-system suppressants are 
prescribed for patients whose surgery is not successful. 


Expected results 

Folic acid and iron deficiency anemia 

It usually takes three to six weeks to correct folic 
acid or iron deficiency anemia. Patients should continue 
taking supplements for another six months to replenish 
iron reserves and should have periodic blood tests to 
make sure the bleeding has stopped and the anemia has 
not recurred. 

Pernicious anemia 

Although pernicious anemia is considered incurable, 
regular B 12 shots will alleviate symptoms and reverse 
complications. Some symptoms will disappear almost as 
soon as treatment begins. 

Aplastic anemia 

Aplastic anemia can sometimes be cured by a bone 
marrow transplant. If the condition is due to immunosup- 
pressive drugs, symptoms may disappear after the drugs 
are discontinued. 

Sickle cell anemia 

Although sickle cell anemia cannot be cured, effec- 
tive treatments enable patients with this disease to enjoy 
longer, more productive lives. 


People with mild thalassemia (alpha thalassemia 
trait or beta thalassemia minor) lead normal lives and do 
not require treatment. Those with severe thalassemia 
may require bone marrow transplantation. Genetic thera- 
py is being investigated and may soon be available. 

Hemolytic anemia 

Acquired hemolytic anemia can generally be cured 
when the cause is removed. 


Inherited anemia cannot be prevented. Genetic 
counseling can help parents cope with questions and 
concerns about passing on disease-causing genes to their 

Avoiding excessive use of alcohol, eating a balanced 
diet that contains plenty of iron-rich foods, and taking a 
daily multivitamin can help prevent anemia. 

Methods of preventing specific types of anemia in- 





Aplastic — Exhibiting incomplete or faulty devel- 

Diabetes mellitus — A disorder of carbohydrate 
metabolism brought on by a combination of 
hereditary and environmental factors. 

Hemoglobin — An iron-containing pigment of red 
blood cells composed of four amino acid chains 
(alpha, beta, gamma, delta) that delivers oxygen 
from the lungs to the tissues of the body. 

Megaloblast — A large erythroblast (a red marrow 
cell that synthesizes hemoglobin). 

• Avoiding lengthy exposure to industrial chemicals and 
drugs known to cause aplastic anemia. 

•Not taking medication that has triggered hemolytic 
anemia and not eating foods that have caused hemoly- 
sis (breakdown of red blood cells). 

• Receiving regular B 12 shots to prevent pernicious ane- 
mia resulting from gastritis or stomach surgery. 



Fauci, Anthony S. et al., eds. Harrison's Principles of Internal 
Medicine. New York: McGraw-Hill, 1998. 

Tierney, Lawrence M., Jr. Current Medical Diagnosis & Treat- 
ment, 1998. Stamford, Conn.: Appleton & Lange, 1998. 

Paula Ford-Martin 



Angelica is a genus of plants in the parsley family 
used in both Western healing and traditional Chinese 
medicine. Usually the dried root is used medicinally. 
The most common angelica used in Western healing is 
the European species, Angelica archangelica. Occasion- 
ally the North American species, A. atropurpurea, is 
used in the same way as A. archangelica. Other names 
for Western Angelica are European angelica, garden an- 
gelica, purple angelica, Alexander’s archangel, master- 
wort, wild angelica, and wild celery. 

Western angelica grows to a height of about 4.5 ft 
(1.5 m) in dappled sun. It has white to yellow flowers, 


and very large three-part leaves. The root is long and fi- 
brous and is poisonous if used fresh. The plant has a 
strong, tangy odor and taste. 

There are at least 10 species of angelica used in tra- 
ditional Chinese medicine. The most frequently used 
species is A. sinensis , which in Chinese is called dong 
quai (alternate spellings are dang gui , tang kwei, and tang 
gui). Other Chinese species include A. pubescens, called 
in Chinese du Into, and A. dahurica , called in Chinese bai 
zhi. The descriptions of the medicinal uses of Chinese an- 
gelica in this article refer only to A. sinensis or dong quai. 

Chinese angelica is a perennial that grows to a 
height of 3 ft ( 1 m) in moist, fertile soil at high altitudes 
in China, Korea, and Japan. It has a purple stem and um- 
brella-like clusters of flowers. The root is used medici- 
nally and as a spice. 

The species of angelica used in Western healing 
have different properties than those used in Eastern med- 
icine, so they will be treated separately here. The reader 
should not assume that any properties or benefits as- 
cribed to Western angelica also apply to Chinese angeli- 
ca or vice versa. 

General use 

Western angelica 

Western angelica, or A. archangelica , is said to have 
been named after an angel who revealed the herb to a Eu- 
ropean monk as a curative. It has a long history of folk use 
in Europe, Russia, and among Native American tribes. 

The leaves of angelica are prepared as a tincture or 
tea and used to treat coughs, colds, bronchitis, and other 
respiratory complaints. They are considered gentler in 
action than preparations made from the root. The root is 
the most medically active part of the plant. It is used as 
an appetite stimulant and to treat problems of the diges- 
tive system and liver. It is said to relieve abdominal 
bloating and gas, indigestion, and heartburn. 

Angelica will induce sweating and is also used to 
treat conditions such as arthritis and rheumatism. In addi- 
tion, it is used as a diuretic. Externally, angelica is applied 
as an ointment to treat lice and some skin disorders. 

In addition to medicinal use, an essential oil derived 
from the plant is used in making perfumes and as a food 
flavoring. Oil from the seeds imparts the distinctive fla- 
vor to the Benedictine liqueur. Sometimes candied leaves 
and stalks are used as sweets. 

Despite its widespread folk use, angelica can present 
some serious health hazards. The root is poisonous when 
fresh and must be dried thoroughly before use. All members 
of the genus contain compounds called furocoumarins that 
can cause a person exposed to the sun or other source of ul- 


traviolet rays to develop severe sunburn and/or rash (photo- 
dermis). In addition, in animal studies, furocoumarins have 
been found to cause cancer and cell damage even without 
exposure to light. The essential oil contains safrole, the can- 
cer-causing substance that caused the United States Food 
and Drug Administration (FDA) to ban the herb sassafras. 

Despite these health concerns, the German Federal 
Health Agency’s Commission E, established in 1978 to 
independently review and evaluate scientific literature 
and case studies pertaining to herb and plant medica- 
tions, has approved preparations containing angelica root 
as a treatment for bloating and as an appetite stimulant. 

Chinese angelica 

Chinese angelica, or dong quai , is considered in tra- 
ditional Chinese medicine (TCM) to have a warm nature 
and a sweet, acrid, and bitter taste. The main use of an- 
gelica in TCM is to regulate the female reproductive or- 
gans and treat irregularities of the menstrual cycle, espe- 
cially deficient bleeding. Chinese herbalists also use this 
herb to treat irregular periods, menstrual cramps, and in- 
fertility. The root is one component of Four Things 
Soup, a widely used woman's tonic in China. 


Dong quai is one of the best known herbs in China, 
and is one of the traditional Chinese herbs that is in- 
creasingly familiar in the West. In addition to treating 
women’s complaints, Chinese angelica is used in general 
blood tonics to improve conditions such as anemia. Be- 
cause angelica is considered to be a warming herb, it is 
also used to aid circulation and digestion. Other uses are 
to treat headache, constipation, rheumatism, high blood 
pressure, and ulcers. 

Dong quai contains several active compounds called 
coumarins. These compounds are well documented as 
agents that dilate (open up) the blood vessels, stimulate 
the central nervous system, and help control spasms. It is 
likely that these compounds do act on the uterus, support- 
ing the use of dong quai for some women’s problems. 

Animal and test-tube studies indicated that dong 
quai may combat allergies by altering the immune sys- 
tem response. Other animal studies suggest that the herb 
is a mild diuretic. 

Unfortunately, dong quai, like Western angelica, 
contains compounds that can cause a person exposed to 
the sun or other source of ultraviolet rays to develop se- 
vere sunburn and/or rash. These problems become more 
severe when using the concentrated essential oil or puri- 





Decoction — Decoctions are made by boiling an 
herb, then straining the solid material out for the 
resulting liquid. 

Diuretic — A diuretic is any substance that increas- 
es the production of urine. 

Tincture — An alcohol-based extract prepared by 
soaking plant parts. 

fied forms of the herb. The essential oil also contains saf- 
role, a known carcinogen. 


Angelica root is harvested in the fall, then dried for 
future use. The leaves of Western angelica can be made 
into a tea ( 1 teaspoon powdered leaves to one cup of boil- 
ing water steeped up to 20 minutes), a tincture, or a cream 
for external use. The root can be made into a tincture or a 
decoction. The essential oil can be combined with other 
oils for external use as a massage oil for arthritis. 

Dong quai is used in many common Chinese formu- 
las and as a component of many medicinal soups. 


Children or pregnant women should not take angelica. 
In light of its potential for causing health problems, com- 
plete avoidance of the herb may be considered desirable. 

Side effects 

In addition to increasing the risk of photodermis, an- 
gelica is considered to be a mild laxative and may cause 

mild diarrhea. 


No studies exist on interactions between angelica 
and conventional pharmaceuticals. Given the history of 
its long use in traditional Chinese medicine, it appears 
unlikely that there are any significant interactions with 
other commonly used Chinese herbs. 



Chevallier. Andrew. Encyclopedia of Medicinal Plants. Lon- 
don: Dorling Kindersley, 1996. 

PDR for Herbal Medicines. Montvale, New Jersey: Medical 
Economics Company, 1999. 


Molony, David. Complete Guide to Chinese Herbal Medicine. 
New York: Berkeley Books, 1998. 

Peirce, Andrea. The American Pharmaceutical Association 
Practical Guide to Natural Medicines. New York: William 
Morrow and Company, 1999. 

Teegaurden. Ron. The Ancient Wisdom of the Chinese Tonic 
Herbs. New York: Warner Books, 1998. 

Weiner, Michael and Janet Weiner. Herbs that Heat. Mill Val- 
ley, CA: Quantum Books, 1999. 


American Association of Oriental Medicine (AAOM). 433 
Front Street, Catasauqua, PA 18032. (610) 266-2433. 


Plants for the Future “Angelica archangelica.” <www.metalab.> 

Plants for the Future "Angelica sinensis.” <www.metalab.unc. 

Tish Davidson 

Angelica archangelica see Angelica 
Angelica sinensis see Dong quai 



Angina is pain, discomfort, or pressure in the chest 
that is caused by ischemia, an insufficient supply of oxy- 
gen-rich blood to the heart muscle. It is sometimes also 
characterized by a feeling of choking, suffocation, or crash- 
ing heaviness. This condition is also called angina pectoris. 


Often described as a muscle spasm and choking sen- 
sation, the term angina is used primarily to describe chest 
(thoracic) pain caused by insufficient oxygen to the heart 
muscle. An episode of angina is not an actual heart attack, 
but rather pain that results when the heart muscle tem- 
porarily receives too little blood. This temporary condition 
may be the result of demanding activities such as exercise 
and does not necessarily indicate that the heart muscle is 
experiencing permanent damage. In fact, episodes of angi- 
na seldom cause permanent damage to heart muscle. 

Angina can be subdivided into two categories: angi- 
na of effort and variant angina. 

Angina of effort 

Angina of effort is a common disorder caused by the 
narrowing of the arteries (a condition called atherosclero- 


sis) that supply oxygen-rich blood to the heart muscle. In 
the case of angina of effort, the coronary arteries can pro- 
vide the heart muscle (myocardium) adequate blood dur- 
ing rest but not during periods of exercise, stress, or ex- 
citement. The resulting pain is relieved by resting or by 
administering nitroglycerin, a medication that relaxes the 
heart muscle, opens up the coronary blood vessels, and 
lowers the blood pressure — all of which reduce the heart’s 
need for oxygen. Patients with angina of effort have an in- 
creased risk of heart attack (myocardial infarction). 

Variant angina 

Variant angina is uncommon and occurs indepen- 
dently of atherosclerosis, which may incidentally be pre- 
sent. Variant angina occurs at rest and is not related to 
excessive work by the heart muscle. Research indicates 
that variant angina is caused by coronary artery muscle 
spasm that does not last long enough or is not intense 
enough to cause an actual heart attack. 

Causes & symptoms 

Angina is usually caused by an underlying obstruc- 
tion to the coronary artery due to atherosclerosis. In 
some cases, it is caused by spasm that occurs naturally or 
as a result of ingesting cocaine. In rare cases, angina is 
caused by a coronary embolism or by a disease other 
than atherosclerosis that places demands on the heart. 

Most episodes of angina are brought on by physical 
exertion, when the heart needs more oxygen than is 
available from the blood nourishing the heart. Emotional 
stress, extreme temperatures, heavy meals, cigarette 
smoking, and alcohol can also cause or contribute to an 
episode of angina. 

Angina causes a pressing pain or sensation of heavi- 
ness, usually in the chest area under the breast bone 
(sternum). It is occasionally experienced in the shoulder, 
arm, neck, or jaw regions. In most cases, the symptoms 
are relieved within a few minutes by resting or by taking 
prescribed angina medications. 


Physicians can usually diagnose angina based on the 
patient’s symptoms and the precipitating factors. Howev- 
er, other diagnostic testing is often required to confirm or 
rule out angina, or to determine the severity of the under- 
lying heart disease. 

Electrocardiogram (ECG) 

An electrocardiogram is a test that records electrical 
impulses from the heart. The resulting graph of electrical 


activity can show if the heart muscle isn’t functioning 
properly as a result of a lack of oxygen. Electrocardio- 
grams are also useful in investigating other possible ab- 
normal features of the heart, such as arrhythmia (irregu- 
lar heartbeat). 

Stress test 

For many individuals with angina, the results of an 
electrocardiogram while at rest will not show any abnor- 
malities. Because the symptoms of angina occur during 
stress, the heart’s function may need to be evaluated 
under the physical stress of exercise. The stress test 
records information from the electrocardiogram before, 
during, and after exercise in search of stress-related ab- 
normalities. Blood pressure is also measured during the 
stress test and symptoms are noted. In some cases a more 
involved and complex stress test (for example, thallium 
scanning) is used to picture the blood flow in the heart 
muscle during the most intense exercise and after rest. 


The angiogram, which is a series of x rays of the 
coronary artery, has been noted as the most accurate diag- 
nostic test to indicate the presence and extent of coronary 
disease. In this procedure, a long, thin, flexible tube 
(catheter) is inserted into an artery located in the forearm 
or groin. This catheter is passed further through the artery 
into one of the two major coronary arteries. A dye is in- 
jected through the catheter to make the heart, arteries, and 
blood flow clearer on the x ray. A fluoroscopic film, or 
series of “moving” x rays, shows the blood flowing 
through the coronary arteries. This will reveal any possi- 
ble narrowing that can cause a decrease in blood flow to 
the heart muscle and associated symptoms of angina. 


Controlling existing factors that place the individual at 
risk is the first step in addressing artery disease that causes 
angina. These risk factors include cigarette smoking, high 
blood pressure, high cholesterol levels, and obesity. 

Once the angina has subsided, the cause should be 
determined and treated. Atherosclerosis, a major associ- 
ated cause, requires diet and lifestyle adjustments, pri- 
marily including regular exercise, reduction of dietary 
sugar and saturated fats, and increase of dietary fiber. 

In recent years, several specific cholesterol-lowering 
treatments have gained the attention and interest of the 
public. One of the most recent popular treatments is garlic 
( Allium sativum). Some studies have shown that garlic can 
reduce total cholesterol by about 10% and LDL (bad) cho- 
lesterol by 15%, and can raise HDL (good) cholesterol by 




10%. Other studies have not shown significant benefit. Al- 
though its effect on cholesterol is not as great as the effect 
achieved by medications, garlic may help in relatively 
mild cases of high cholesterol, without causing the side ef- 
fects associated with cholesterol-reducing drugs. 

A 1999 study published in the American Journal of 
Clinical Nutrition found that red yeast extract can signifi- 
cantly reduce cholesterol when it’s taken in conjunction 
with a low-fat diet. Red yeast extract, available in the Unit- 
ed States under the trade name Cholestin, has been used in 
Chinese medicine to treat heart maladies for hundreds of 
years. The effectiveness of the extract depends on the pa- 
tient’s cholesterol level and medical history, so individuals 
should consult with their healthcare professionals before 
taking the supplement. Additional herbal remedies that 
may help lower cholesterol include oats ( Avena sativa), al- 
falfa ( Medicago sativa ), fenugreek (Trigonella foenum- 
graecum ), Korean ginseng ( Panax ginseng), myrrh 
(Commiphora molmol ), and turmeric (Curcuma longa). 

Yarrow (Achillea millefolium ), linden (Tilia eu- 
ropaea), and hawthorn (Crataegus spp.) are sometimes 
recommended for controlling high blood pressure, a risk 
factor for heart disease. In particular, hawthorn extract 
appears to benefit the aging heart. A 2001 report of a Eu- 
ropean study reported that patients using hawthorn ex- 
tract showed improvements in exercise tolerance, fa- 
tigue, and shortness of breath. 

Tea (Camellia sinensis) — especially green tea — is 
high in antioxidants, and studies have shown that it may 
help prevent atherosclerosis. Other antioxidants, includ- 
ing vitamin A (beta carotene), vitamin C, vitamin E, 
and selenium, can also limit the damage to the walls of 
blood vessels by oxidation, which may be lead to the for- 
mation of atherosclerotic plaque. 

Vitamin and mineral supplements that reduce, re- 
verse, or protect against coronary artery disease include 
chromium, calcium and magnesium, B-complex vita- 
mins, L-carnitine, and zinc. Yoga and other bodywork, 
massage, aromatherapy, and music therapy may also 
help reduce angina symptoms by promoting relaxation 
and stress reduction. 

Traditional Chinese medicine may recommend 
herbal remedies (such as a ginseng and aconite combina- 
tion), massage, acupuncture, and dietary modification. 
Exercise and a healthy diet, including cold-water fish as a 
source of essential fatty acids, are important components 
of a regimen to prevent angina and heart disease. 

Allopathic treatment 

Angina is often controlled by medication, most 
commonly with nitroglycerin. This drug relieves symp- 


toms of angina by increasing the diameter of the blood 
vessels that carry blood to the heart muscle. Nitroglyc- 
erin is taken whenever discomfort occurs or is expected. 
It may be taken sublingually, by placing the tablet under 
the tongue. Or it may be administered transdermally, by 
placing a medicated patch directly on the skin. 

In addition, beta-blockers or calcium channel block- 
ers may be prescribed to decrease the heart’s rate and 
workload. In late 2001, a study reported that the drug 
Nicorandil had become the first to demonstrate a reduc- 
tion in risk of angina and to improve symptoms in patients 
with chronic stable angina. Guidelines released late in 
2000 promoted use of lopidogrel to help prevent recurring 
events. A study group that used clopidogrel and aspirin 
showed a significant decrease in cardiovascular death, 
nonfatal heart attack, and stroke compared to patients in a 
control group that received a placebo and aspirin. 

When conservative treatments are not effective in 
reducing angina pain and the risk of heart attack remains 
high, physicians may recommend angioplasty or surgery. 
In coronary artery bypass surgery, a blood vessel (often a 
long vein surgically removed from the leg) is grafted 
onto the blocked artery to bypass the blocked portion. 
This newly formed pathway allows blood to flow ade- 
quately to the heart muscle. 

Another procedure used to improve blood flow to 
the heart is percutaneous tranluminal coronary angio- 
plasty, usually called coronary or balloon angioplasty. In 
this procedure, the physician inserts a catheter with a 
tiny balloon at the end into a forearm or groin artery. The 
catheter is then threaded up into the coronary arteries, 
and the balloon is inflated to open the vessel in narrowed 
sections. Other techniques to open clogged arteries are 
under development and in limited use, including the use 
of lasers, stents, and other surgical devices. 

Expected results 

The prognosis for a patient with angina depends on 
the general health of the individual as well as on the ori- 
gin, type, and severity of the condition. A person can im- 
prove his or her prognosis by seeking prompt medical at- 
tention and learning the pattern of his or her angina, such 
as what causes the attacks, what they feel like, how long 
episodes usually last, and whether medication relieves 
the attacks. Medical help should be sought immediately 
if patterns of the symptoms change significantly or if 
symptoms resemble those of a heart attack. 


In most cases, the best prevention involves changing 
habits to avoid bringing on attacks of angina. A heart- 



Atherosclerosis — Progressive narrowing and hard- 
ening of the arteries caused by the buildup of 
plaque on the artery walls, which results in re- 
stricted blood flow. 

Ischemia — Decreased blood supply to an organ or 
body part, often resulting in pain. 

Myocardial infarction — A blockage of a coronary 
artery that cuts off the blood supply to part of the 
heart. In most cases, the blockage is caused by 
fatty deposits. 

Myocardium — The thick middle layer of the heart 
that forms the bulk of the heart wall and contracts 
as the organ beats. 

healthy lifestyle includes eating right, exercising regularly, 
maintaining an appropriate weight, not smoking, drinking 
in moderation, controlling hypertension, and managing 
stress. Most healthcare professionals can provide valuable 
advice on proper diet, weight control, smoking cessation, 
blood cholesterol levels, and blood pressure. 



American Heart Association. 2000 Heart and Stroke Statistical 
Update. Dallas: American Heart Association, 1999. 
Hoffmann, David. The Complete Illustrated Herbal. New York: 
Barnes & Noble, 1999. 


Jancin, Bruce. “Nicorandil Relieves Stable Angina, Cuts 
Events.” Interna! Medicine News 34, no. 24 (December 
15,2001): 11. 

Pinkowish, Mary Desmond. ‘‘Acute Coronary Syndromes: Re- 
cent Treatment Advances." Patient Care 35, no. 22 (No- 
vember 30, 2001): 12. 

Walsh, Nancy. ‘‘Hawthorn Extract Limits CHF, Mild Heart Ail- 
ments." Internal Medicine News 34. no. 19 (October 1, 
2001): 9. 


American Heart Association. National Center. 7272 Greenville 
Avenue. Dallas, Texas 75231. (800) AHA-USA1. <http://>. 

National Heart, Lung, and Blood Institute Information Center. 
P.O. Box 30105. Bethesda, MD 20824. (301) 251-1222. 

Paula Ford-Martin 
Teresa G. Odle 


Animal-assisted therapy see Pet therapy 



Anise, Pimpinella anisum, is a slow-growing annual 
herb of the parsley family (Apiaceae, formerly Umbellif- 
erae). It is related to other plants prized for their aromatic 
fruits, commonly called seeds, such as dill, cumin, car- 
away, and fennel. It is cultivated chiefly for its licorice- 
flavored fruits, called aniseed. Although it has a licorice 
flavor, anise is not related to the European plant whose 
roots are the source of true licorice. It has been used as a 
medicinal and fragrant plant since ancient times. 

The plant reaches from 1-3 ft (0.3-1 m) in height 
when cultivated, and has finely divided feather-like 
bright green leaflets. The name Pimpinella (from the 
Latin dipinella) refers to the pinnately divided form of 
the leaves. The plant bears white to yellowish-white 
flowers in compound umbels (umbrella-like clusters). 
When ripe, the fruits are 0.125 in (3 mm) long and oval- 
shaped with grayish-green coloring. 

While the entire plant is fragrant and tastes strongly 
of anise, it is the aniseed fruit that has been highly val- 
ued since antiquity. Seed maturation usually occurs one 
month after pollination, when the oil content in the dried 
fruit is about 2.5%. Steam distillation of the crushed 
aniseed yields from 2.5 to 3.5% of a fragrant, syrupy, es- 
sential, or volatile, oil, of which anethole, present at 
about 90%, is the principal aromatic constituent. Other 
chemical constituents of the fruit are creosol, alpha- 
pinene, dianethole, and photoanethole. 

In addition to its medicinal properties, anise is wide- 
ly used for flavoring curries, breads, soups, cakes, can- 
dies, desserts, nonalcoholic beverages, and liqueurs such 
as anisette. The essential oil is valuable in perfumes and 
soaps and has been used in toothpastes, mouthwashes, 
and skin creams. 

Anise is endemic to the Middle East and Mediter- 
ranean regions, including Egypt, Greece, Crete, and Turkey. 
It was cultivated and used by ancient Egyptians, and used in 
ancient Greece and Rome, when it was cultivated in Tus- 
cany. Its use and cultivation spread to central Europe in the 
Middle Ages, and today it is cultivated on a commercial 
scale in warm areas such as southern Europe, Asia, India, 
North Africa, Mexico, and Central and South America. 

General use 

The medicinal properties of anise come from the 
chemicals that are present in the fruits. The anethole in 




anise helps to relieve gas and settle an upset stomach. The 
use of anise to season foods, especially meat and vegetable 
dishes, in many parts of the world may have originated as a 
digestive aid. The Romans ate aniseed cake at the end of 
rich meals to prevent indigestion. The chemicals creosol 
and alpha-pinene act as expectorants, loosening mucus and 
making it easier to cough up. The estrogenic action of 
anise is from the chemicals dianethole and photoanethole, 
which act in a way similar to estrogen. The anise fruits and 
the essential oil of anise contain these chemicals and can 
be used medicinally. Aniseed can also be used to make an 
herbal tea which can help relieve physical complaints. 

As a medicinal plant, anise has been used as an antibac- 
terial, an antimicrobial, an antiseptic, an antispasmodic, a 
breath freshener, a carminative, a diaphoretic, a digestive 
aid, a diuretic, an expectorant, a mild estrogenic, a mild 
muscle relaxant, a parasiticide, a stimulant, and a stomachic. 

Anise may be helpful in the following conditions: 

• Anemia. Anise promotes digestion, which may help 
improve anemia due to inefficient absorption of iron. 

• Asthma. Essential oil of anise may be inhaled through 
the nose to help ease breathing and relieve nasal con- 


• Bad breath. It can be used in mouthwash or tea to 
sweeten breath. 

• Bronchitis. Aniseed may be used as an expectorant and 
essential oil of anise may be inhaled through the nose 
to help ease breathing. 

• Catarrh. Drinking aniseed tea soothes mucous mem- 

• Cold. Aniseed can be used as an expectorant and drink- 
ing aniseed tea soothes the throat. 

• Colic. Drinking anise tea or using essential oil can alle- 
viate gas. 

• Cough. Can be used as an expectorant, especially for 
hard, dry coughs where expectoration is difficult. 

• Croup. Aniseed can be used to alleviate a persistent 
cough in a child. 

• Emphysema. Essential oil of anise may be inhaled 
through the nose to help ease breathing and relieve 
nasal congestion and tea with aniseed will soothe mu- 
cous membranes. 

• Gas and gas pains. Drinking aniseed tea helps relieve 
gas, gas pains, and flatulence. 


• Menopause. Aniseed tea can help alleviate menopausal 

• Morning sickness. Tea made from anise can help alle- 
viate morning sickness during pregnancy. 

• Nursing. Aniseed tea can help a nursing mother’s milk 
come in. 

• Sore throat. Drinking aniseed tea alleviates pain of 
sore throat. 


Aniseeds. May be added to foods when cooking to 
flavor and aid digestion, or may be taken whole in doses 
of 1-3 tsp of dried anise seeds per day. 

Tea. One tsp of crushed aniseeds can be steeped in a 
cup of hot water, then combined with fennel and car- 
away to help relieve gas and gas pains. To help relieve a 
cough, coltsfoot, marsh mallow, hyssop, and licorice 
can be added to the tea. Infants should only receive 1 tsp 
of boiled, prepared tea. 

Essential oil. Preparations of essential oil of anise 
can be used for inhalation. The essential oil may be 
taken orally at a dose of 0.01 oz (0.3 g) per day. In addi- 
tion, the liqueur anisette, which contains anise essential 
oil, may be administered in hot water to help relieve 
problems in the bronchial tubes, such as bronchitis and 
spasmodic asthma. One to three drops of essential oil ad- 
ministered on sugar may help relieve colic. 


Persons allergic to anise or anethole, its main ingre- 
dient, should avoid using aniseed or its essential oil. It is 
also possible to develop an allergic sensitivity to anise. 
Care should be taken to monitor the quantity of aniseed 
oil given to infants. A 2002 report noted an infant 
brought to the emergency department with seizures as a 
result of multiple doses of aniseed oil tea. 

Side effects 

Although anise is generally considered safe, the side 
effects of its estrogenic property have not been fully 
studied. Anise oil may induce nausea, vomiting, 
seizures, and pulmonary edema if it is ingested in suffi- 
cient quantities. Also, contact of the skin with the con- 
centrated oil can cause irritation. 

It is important to note that Japanese Star Anise is not 
the same herb — it is poisonous. 



Anemia — Condition in which the blood is defi- 
cient in red blood cells, in hemoglobin, or in total 

Antiseptic — A substance that checks the growth or 
action of microorganisms especially in or on liv- 
ing tissue. 

Antispasmodic — A substance capable of preven- 
tion or relieving spasms or convulsions. 

Carminative — A substance that expels gas from 
the alimentary canal to relieve colic or griping. 

Catarrh — Inflammation of a mucous membrane, 
especially of the nose and air passages. 

Diaphoretic — A substance that increases perspira- 

Diuretic — A substance that increases the flow of 

Estrogenic — A substance that promotes estrus, the 
state in which a woman is capable of conceiving. 
Expectorant — A substance that promotes the dis- 
charge or expulsion of mucus. 

Parasiticide — A substance destructive to parasites. 
Stomachic — A stimulant or tonic for the stomach. 


No interactions have been reported. 



Foster, Gertrude B. and Rosemary F. Louden. Park’s Success 
with Herbs. Greenwood, S. C.: G. W. Park Seed Co., 1980. 

Grieve, M. A Modern Herbal: The Medicinal, Culinary, Cos- 
metic and Economic Properties, Cultivation and Folk-lore 
of Herbs, Grasses, Fungi, Shrubs, & Trees with All Their 
Modern Scientific Uses. New York: Harcourt, Brace and 
Co., 1931. 

Reader’s Digest Editors. Magic and Medicine of Plants. Pleas- 
antville, N.Y.: Reader’s Digest Association, 1986. 

Simon, James E., Alena F. Chadwick and Lyle E. Craker. 
Herbs: An Indexed Bibliography, 1971-1980: The Scien- 
tific Literature on Selected Herbs, and Aromatic and Med- 
icinal Plants of the Temperate Zone. Hamden, Conn.: Ar- 
chon Books, 1984. 


Tuckler, V., et al. “Seizure in an Infant from Aniseed Oil Toxic- 
ity.” Clinical Toxicology (August 2002): 689. 



Ankylosing spondylitis 


Herb Society of America, 
(July 12, 2000). 

“Herbs." Department of Horticulture, Pennsylvania State Uni- 
laanisum.html/ (July 12, 2000). 

One Planet, (July 

12, 2000). 

“Pimpinella anisurn.” 
1677.57580/ (July 12,2000). 

Melissa C. McDade 
Teresa G. Odle 

Ankylosing spondylitis 


Ankylosing spondylitis (AS) is a systemic disorder that 
refers to inflammation of the joints in the spine. AS is the 
primary disease in an entire group of conditions known as 
seronegative spondylarthropathies. It is also known as 
rheumatoid spondylitis or Marie-Striimpell disease (among 
other names). AS is an autoimmune disease, as are most 
forms of arthritis. By definition, other joints, in addition to 
the spine, can also be affected, including the shoulders, 
hips, knees, and feet. Tissues in the eye can also be affected. 


A form of arthritis, AS is characterized by chronic 
inflammation, causing pain and stiffness of the back, 
progressing to the chest and neck. Eventually, the whole 
back may become curved and inflexible if the bones 
fuse, which is known as “bamboo spine.” Other condi- 
tions associated with AS include reactive arthritis, psori- 
atic arthritis, spondylitis of inflammatory bowel dis- 
ease, and undifferentiated spondy arthropathy. AS may 
involve multiple organs, such as the: 

• eye (causing an inflammation of the iris, or iritis) 

• heart (causing aortic valve disease) 

• lungs 

• skin (causing a scaly skin condition, or psoriasis) 

• gastrointestinal tract (causing inflammation within the 
small intestine, called ileitis, or inflammation of the 
large intestine, called colitis). 

Less than 1% of the population has AS; however, 
20% of AS sufferers have a relative with the disorder. 

Causes & symptoms 

Genetics, in the form of a gene named HLA-B27, 
can play an important role in the disease, but the precise 


cause of AS remains unknown. According to information 
from the Spondylitis Association of America, HLA-B27 
is a perfectly normal gene found in 8% of the general 
population. Generally speaking, no more than 2% of 
people born with this gene will eventually get spondyli- 
tis. The gene itself does not cause spondylitis, but people 
with HLA-B27 are more susceptible to getting spondyli- 
tis. To date, 15 subtypes of HLA-B27 have been identi- 
fied. The most common subtypes in the United States 
being B27.05, and then after that B27.02. The way in 
which HLA-B27 interacts with some other proteins 
seems to be very important to the cause of AS, but fur- 
ther research must be conducted to find out exactly how. 
According to information published in 1997 from The 
Arthritis Cure, by Dr. Jason Theodosakis, M.D., M.S., 
M. P. H., and others, research was being conducted re- 
garding the possibility that a certain type of infection 
could be the trigger for the onset of AS. 

Symptoms of AS include: 

• low back and hip pain and stiffness 

• duration of symptoms longer than three months 

• difficulty expanding the chest 

• early morning stiffness improved by a warm shower or 
light exercise 

• pain in the neck, shoulders, knees, and ankles 

• low-grade fever 

• fatigue 

• weight loss 

AS occurs most often in males between 16 and 35 
years of age. Initial symptoms are uncommon after the 
age of 30, although the diagnosis may not be established 
until after that age. The incidence of AS in African 
Americans is about 25% of incidence among Cau- 
casians, but is rarely seen in that population. 

Some naturopathic healers link the cause of AS to 
its autoimmune origins in food allergies and abnormal 
bowel function, sometimes referred to as “leaky gut” 
syndrome. According to this theory, food allergies com- 
bine with the leaky gut and, according to the Healing- 
WithNutrition website, from a 1986 article in the Britain 
Journal of Rheumatology, “..result in the increased circu- 
lation of gut-derived antigens into other areas of the 
body. The body produces antibody-antigen complexes 
(immune complexes) characteristic of RA (rheumatoid 
arthritis) to battle these gut-derived foreign antigens; 
but these antibody-antigens are thought to also cross- 
react with antigens in the joint tissues. In other words, 
the antibodies formed to attack the (leaky gut) microbes 
also cross-react and attack joint collagen.” 



Doctors usually diagnose the disease simply by the 
patient’s report of pain and stiffness. Doctors also review 
spinal and pelvic x rays since involvement of the hip and 
pelvic joints is common and may be the first abnormality 
seen on the x ray. The doctor might also order a blood 
test to determine the presence of HLA-B27 antigen if 
the x rays have not clearly determined the diagnosis. If 
the gene is present, it could facilitate the accuracy of the 
possible AS diagnosis. When a diagnosis is made, pa- 
tients may be referred to a rheumatologist, a doctor who 
specializes in treating arthritis. Patients may also be re- 
ferred to an orthopedic surgeon, a doctor who can surgi- 
cally correct joint or bone disorders. 


To reduce inflammation, various herbal remedies, 
including white willow ( Salix alba), yarrow ( Achillea 
millefolium), and lobelia ( Lobelia Inflata), may be help- 
ful. Acupuncture, performed by a trained professional, 
has helped some patients manage their pain. Homeopath- 
ic practitioners may prescribe such remedies as Bryonia 
and Rhus toxicodendron for pain relief. 

A key alternative treatment for AS is massage ther- 
apy. Reported benefits include a decrease in pain, in- 
crease in circulation, lymph flow improvement, and in- 
crease in range of motion. The major benefit of this ther- 
apy could be that it provides further motivation for a reg- 
ular excerise program, considered the most beneficial of 
all treatments for AS. 

Diets of various regimens have been offered that in- 
clude supplements of fatty acids and antioxidants, as 
with other arthritis diets. Naturopaths and some medical 
doctors have theorized that certain foods should be elim- 
inated from the diet in order to alleviate symptoms. Pos- 
sible problem foods include wheat, corn, milk and other 
dairy products, beef, tomatoes, potatoes, and peppers. 
Tobacco has also been thought to aggravate the condi- 
tion. Various reports have surfaced in many books and 
articles that indicate a diet high in fiber and fresh fruits 
and vegetables — minus those listed above — and low in 
sugar, meat, refined carbohydrates, and animal fats 
might help in the treatment of the symptoms, particularly 
with pain or swelling. 

Allopathic treatment 

Nonsteroidal anti-inflammatory drugs (NSAIDs), 
like naproxen (Naprosyn) or indomethacin (Indocin) are 
used to relieve pain and stiffness. In severe cases, sul- 
fasalazine (Azulfidine), another drug to reduce inflam- 
mation, or methotrexate (Rheumatrex), an immune-sup- 


pressing drug, are recommended. In cases where chronic 
therapy is needed, potential drug side effects must be 
taken into consideration. Corticosteroid drugs are effec- 
tive in relieving symptoms, but are usually reserved for 
severe cases that do not improve when NSAIDs are used. 
To avoid potential side effects, treatment with corticos- 
teroids is usually limited to a short amount of time with a 
gradual weaning from the drug. 

In April 2002, a study published revealed that a drug 
already approved for patients with rheumatoid arthritis 
was successful in helping most AS patients as well. In- 
fliximab helped alleviate pain and improved functioning 
in more than 80 % of patients in a clinical trial. The drug 
worked rapidly and reduced disease activity by more 
than half in about 50% of patients. Some serious side ef- 
fects did occur, so researchers continued to test the drug 
and seek Food and Drug Administration (FDA) approval 
for Infliximab for AS patients. In the same year, scien- 
tists were testing another drug called Etanercept that also 
showed promising results in preliminary trials. 

Physical therapists prescribe exercises to prevent a 
stooped posture and breathing problems when the spine 
starts to fuse and ribs are affected. Back braces may be 
used to prevent continued deformity of the spine and 
ribs. Only in severe cases of deformity is surgery per- 
formed to straighten and realign the spine, or to replace 
knee, shoulder, or hip joints. Because it is a major and 
complicated procedure, with a potential for complica- 
tions, this surgery is recommended cautiously even in se- 
vere cases. 

Expected results 

There is no cure for AS, and the course of the dis- 
ease is unpredictable. Generally, AS progresses for about 
10 years, then levels off. Most patients can lead normal 
lives with treatment to control symptoms. Claims that 
homeopathic remedies have cured them have not been 


There is no known way to prevent AS. With twenty- 
first century advances in gene therapy, the possibility ex- 
ists for further determination of the factor that HLA-B27 
gene plays in its manifestation, and what role it could 
play in preventing it for future generations. 



Brewer Jr., Earl J., and Kathy Cochran Angel. The Arthritis 

Sourcebook. Los Angeles: Lowell House, 1993. 

Swezey, Robert L. Straight Talk on Spondylitis. Spondylitis As- 
sociation of America, 1994. 


Ankylosing spondylitis 

Anorexia nervosa 


Ankylosing — When bones of a joint are fused, 
stiff, or rigid. 

HLA-B27 — An antigen or protein marker on cells 
that may indicate ankylosing spondylitis. 

Immune suppressing — Anything that reduces the 
activity of the immune system. 

Inflammation — A reaction of tissues to disease or 
injury, often associated with pain and swelling. 

Spondylitis — An inflammation of the spine. 

Taurog, Joel D., and Peter E. Lipsky. "Ankylosing Spondylitis, 
Reactive Arthritis, and Undifferentiated Spondy- 
loarthropathy.” In Harrison's Principles of Internal Medi- 
cine, edited by Anthony S. Fauci, et al. New York: Mc- 
Graw-Hill, 1998. 


Babayev, Marietta and Leonard Bleicher. “Low Back Pain in an 
Elderly Man.” The Journal of Musculoskeletal Medicine 
(April 2000). 

Breban, M., B. Gombert, et al. “Thalidomide: A New Use in 
Ankylosing Spondylitis?” Rheumatoid Arthritis Research 
News (April 1999). 

“Etanercept for ‘Rapid Improvement’ in Joint Disease.” 
Chemist & Druggist (May 18, 2002): 24. 

Feldtkeller, et al. “Impact of Sex on Inheritance of Ankylosing 
Spondylitis.” The Lancet (March 25, 2000). 

“Infliximab Highly Effective Therapy.” Immunotherapy Weekly 
(May 8, 2002): 3. 

Nuki, George. “Ankylosing Spondylitis, HLA B27, and Be- 
yond.” The Lancet (14 March 1998). Available from http:// 
web2 . inf otrac . galegroup .com . 

Sussman, Sharon. “Now He’s Blind.” Discover (June 1999). 

Yacyshyn, Elaine A. and Marc D. Cohen. “Ankylosing 
Spondylitis: Early Detection and Management.” The Jour- 
nal of Musculoskeletal Medicine (December 1999). 


Arthritis Foundation. 1330 West Peachtree St., Atlanta, GA 
30309. (404) 872-7100. 

National Institute of Arthritis and Musculoskeletal and Skin 
Diseases Information Clearinghouse. 1 AMS Circle, 
Bethesda, MD 29892-3675. (301) 495-4484. 

Spondylitis Association of America. PO Box 5872, Sherman 
Oaks, CA 91413. (800) 777-8189. 


Harris, Brian. The Ankylosing Spondylitis Site. http://www. (2000). 

Healing WithNutrition. 


Matsen III, Frederick, ed. “Ankylosing Spondylitis.” http:// 
(December 2000). 

Penn State University, Department of Orthopaedics and Reha- 
bilitation, M. S. Hershey Medical Center. Adult Spin 
Surgery Service, (December 

The Spondylitis Association of America. http://www.spondy (December 2000). 

Jane Spear 
Teresa G. Odle 

Anorexia nervosa 


Anorexia nervosa is an eating disorder characterized 
by unrealistic fear of weight gain, self-starvation, and 
conspicuous distortion of body image. The name comes 
from two Latin words that mean “nervous inability to 
eat.” In females who have begun to menstruate, anorexia 
nervosa is usually marked by amenorrhea, or skipping at 
least three menstrual periods in a row. The fourth edition 
of the Diagnostic and Statistical Manual of Mental Dis- 
orders, or DSM-IV (1994), defines two subtypes of 
anorexia nervosa — a restricting type, characterized by 
strict dieting and exercise without binge eating — and a 
binge-eating/purging type, marked by episodes of com- 
pulsive eating with or without self-induced vomiting and 
the use of laxatives or enemas. DSM-IV defines a binge 
as a time-limited (usually under two hours) episode of 
compulsive eating in which the individual consumes a 
significantly larger amount of food than most people 
would eat in similar circumstances. 


Anorexia nervosa was not officially classified as a 
psychiatric disorder until the third edition of DSM in 
1980. It is, however, a growing problem among adoles- 
cent females and its incidence in the United States has 
doubled since 1970. The rise in the number of reported 
cases reflects a genuine increase in the number of per- 
sons affected by the disorder, not simply earlier or more 
accurate diagnosis. Estimates of the incidence of anorex- 
ia range between 0.5-1% of Caucasian female adoles- 
cents. Over 90% of patients diagnosed with the disorder 
as of 1998 were female. It was originally thought that 
only 5% of anorexics are male, but that estimate is being 
revised upward. The peak age range for onset of the dis- 
order is 14-18 years, although there are patients who de- 


velop anorexia as late as their 40s. In the 1970s and 
1980s, anorexia was regarded as a disorder of upper- and 
middle-class women, but that generalization is also 
changing. More recent studies indicate that anorexia is 
increasingly common among women of all races and so- 
cial classes in the United States. 

Anorexia nervosa is a serious public health problem 
not only because of its rising incidence, but also because 
it has one of the highest mortality rates of any psychi- 
atric disorder. Moreover, the disorder may cause serious 
long-term health complications, including congestive 
heart failure, sudden death, growth retardation, dental 
problems, constipation, stomach rupture, swelling of the 
salivary glands, loss of kidney function, osteoporosis, 
anemia and other abnormalities of the blood. 

Causes & symptoms 

Anorexia is a disorder that results from the interac- 
tion of cultural and interpersonal as well as biological 
factors. While the precise cause of the disease is not 
known, it has been linked to the following: 

Social influences 

The rising incidence of anorexia is thought to reflect 
the present idealization of thinness as a badge of upper- 
class status as well as of female beauty. In addition, the 
increase in cases of anorexia includes “copycat” behav- 
ior, with some patients developing the disorder from imi- 
tating other girls. 

The onset of anorexia in adolescence is attributed to 
a developmental crisis caused by girls’ changing bodies 
coupled with society’s overemphasis on women’s looks. 
The increasing influence of the mass media in spreading 
and reinforcing gender stereotypes has also been noted. 

Occupational goals 

The risk of developing anorexia is higher among 
adolescents preparing for careers that require attention to 
weight and/or appearance. These high-risk groups in- 
clude dancers, fashion models, professional athletes (in- 
cluding gymnasts, skaters, long-distance runners, and 
jockeys), and actresses. 

Genetic and biological influences 

Women whose biological mothers or sisters have the 
disorder appear to be at increased risk. 

Psychological factors 

A number of theories have been advanced to explain 
the psychological aspects of the disorder. No single ex- 


The body of a woman with anorexia. (Photograph by Biopho- 
to Associates/Science Source. Photo Researchers, Inc. Repro- 
duced by permission.) 

planation covers all cases. Anorexia nervosa has been in- 
terpreted as: 

• A rejection of female sexual maturity. This rejection is 
variously interpreted as a desire to remain a child, or as 
a desire to resemble men as closely as possible. 

• A reaction to sexual abuse or assault. 

• A desire to appear as fragile and non-threatening as 
possible. This hypothesis reflects the idea that female 
passivity and weakness are attractive to men. 

• Overemphasis on control, autonomy, and independence. 
Some anorexics come from achievement-oriented fami- 
lies that stress physical fitness and dieting. Many 
anorexics are perfectionists and “driven” about school- 
work and other matters in addition to weight control. 

• Evidence of family dysfunction. In some families, a 
daughter’s eating disorder serves as a distraction from 
marital discord or other family tensions. 


Anorexia nervosa 

Anorexia nervosa 

• Inability to interpret the body’s hunger signals accurate- 
ly due to early experiences of inappropriate feeding. 

Male anorexics 

Although anorexia nervosa is still considered a dis- 
order that largely affects women, its incidence in the 
male population is rising. Less is known about the caus- 
es of anorexia in males, but some risk factors are the 
same as for females. These include certain occupational 
goals and increasing media emphasis on external appear- 
ance in men. Moreover, homosexual males are under 
pressure to conform to an ideal body weight that is about 
20 pounds lighter than the standard “attractive” weight 
for heterosexual males. 


Diagnosis of anorexia nervosa is complicated by a 
number of factors. One is that the disorder varies some- 
what in severity from patient to patient. A second factor 
is denial, which is regarded as an early sign of the disor- 
der. Most anorexics deny that they are ill and are usually 
brought to treatment by a family member. 

Anorexia is usually diagnosed by pediatricians or 
family practitioners. Anorexics develop emaciated bod- 
ies, dry or yellowish skin, and abnormally low blood 
pressure. There is usually a history of amenorrhea (failure 
to menstruate) in females, and sometimes of abdominal 
pain, constipation, or lack of energy. The patient may 
feel chilly or have developed lanugo, a growth of downy 
body hair. If the patient has been vomiting, she may have 
eroded tooth enamel or Russell’s sign (scars on the back 
of the hand). The second step in diagnosis is measure- 
ment of the patient’s weight loss. DSM-IV specifies a 
weight loss leading to a body weight 15% below normal, 
with some allowance for body build and weight history. 

The doctor will rule out other physical conditions 
that can cause weight loss or vomiting after eating, in- 
cluding metabolic disorders, brain tumors (especially hy- 
pothalamus and pituitary gland lesions), diseases of the 
digestive tract, and a condition called superior mesen- 
teric artery syndrome. Persons with this condition some- 
times vomit after meals because the blood supply to the 
intestine is blocked. The doctor will usually order blood 
tests, an electrocardiogram, urinalysis, and bone densito- 
metry (bone density test) in order to exclude other dis- 
eases and to assess the patient's nutritional status. 

The doctor will also need to distinguish between 
anorexia and other psychiatric disorders, including de- 
pression, schizophrenia, social phobia, obsessive-com- 
pulsive disorder, and body dysmorphic disorder. Two di- 
agnostic tests that are often used are the Eating Attitudes 
Test (EAT) and the Eating Disorder Inventory (EDI). 



Alternative treatments should serve as complemen- 
tary to a conventional treatment program. Alternative 
therapies for anorexia nervosa include diet and 

nutrition, herbal therapy, hydrotherapy, aromathera- 
py, Ayurveda, and mind/body medicine. 

Nutritional therapy 

A naturopath or nutritionist may recommend the fol- 

• avoiding sweets or baked goods 

• following a nutritious and well-balanced diet (when pa- 
tients resume eating normally) 

• gaily multivitamin and mineral supplements 

• zinc supplements. (Zinc is an important mineral needed 
by the body for normal hormonal activity and enzymat- 
ic function) 

Herbal therapy 

The following herbs may help reduce anxiety and 
depression which are often associated with this disorder: 

• chamomile ( Matricaria recutita) 

• lemon balm (Melissa officinalis ) 

• linden (Tilia spp.) flowers 


Essential oils of herbs such as bergamot, basil, 
chamomile, clary sage and lavender may help stimulate ap- 
petite, relax the body and fight depression. They can be dif- 
fused into the air, inhaled, massaged or put in bath water. 

Relaxation techniques 

Relaxation techniques such as yoga, meditation 
and t’ai chi can relax the body and release stress, anxiety 
and depression. 


Hypnotherapy may help resolve unconscious is- 
sues that contribute to anorexic behavior. 

Other alternative treatments 

Other alternative treatments that may be helpful in- 
clude hydrotherapy, magnetic field therapy, acupuncture, 
biofeedback, Ayurveda and Chinese herbal medicine. 

Allopathic treatment 

Treatment of anorexia nervosa includes both short- 
term and long-term measures, and requires assessment 


by dietitians and psychiatrists as well as medical special- 
ists. Therapy is often complicated by the patient’s resis- 
tance or failure to carry out treatment plan. 

Hospital treatment 

Hospitalization is recommended for anorexics with 
any of the following characteristics: 

• weight of 40% or more below normal, or weight loss 
over a three-month period of more than 30 pounds 

• severely disturbed metabolism 

• severe binging and purging 

• signs of psychosis 

• severe depression or risk of suicide 

• family in crisis 

Hospital treatment includes individual and group 
therapy as well as refeeding and monitoring of the pa- 
tient's physical condition. Treatment usually requires 
two to four months in the hospital. In extreme cases, hos- 
pitalized patients may be force-fed through a tube insert- 
ed in the nose (nasogastric tube) or by over-feeding (hy- 
peralimentation techniques). 

Outpatient treatment 

Anorexics who are not severely malnourished can be 
treated by outpatient psychotherapy. The types of treat- 
ment recommended are supportive rather than insight-ori- 
ented, and include behavioral approaches as well as indi- 
vidual or group therapy. Family therapy is often recom- 
mended when the patient’s eating disorder is closely tied 
to family dysfunction. Self-help groups are often useful 
in helping anorexics find social support and encourage- 
ment. Psychotherapy with anorexics is a slow and diffi- 
cult process; about 50% of patients continue to have seri- 
ous psychiatric problems after their weight has stabilized. 


Anorexics have been treated with a variety of med- 
ications, including antidepressants, anti-anxiety drugs, 
selective serotonin reuptake inhibitors, and lithium car- 
bonate. The effectiveness of medications in treatment 
regimens is still debated. However, at least one study of 
Prozac showed it helped the patient maintain weight 
gained while in the hospital. 

Expected results 

Figures for long-term recovery vary from study to 
study, but the most reliable estimates are that 40-60% of 
anorexics will make a good physical and social recovery, 
and 75% will gain weight. The long-term mortality rate 



Amenorrhea — Absence of menstruation in a fe- 
male who has begun to have menstrual periods. 

Binge eating — A pattern of eating marked by 
episodes of rapid consumption of large amounts 
of food, usually food that is high in calories. 

Body dysmorphic disorder — A psychiatric disor- 
der marked by preoccupation with an imagined 
physical defect. 

Hyperalimentation — A method of refeeding 
anorexics by infusing liquid nutrients and elec- 
trolytes directly into central veins through a 

Lanugo — A soft, downy body hair that develops 
on the chest and arms of anorexic women. 

Purging — The use of vomiting, diuretics, or laxa- 
tives to clear the stomach and intestines after a 

Russell's sign — Scraped or raw areas on the pa- 
tient's knuckles, caused by self-induced vomiting. 

Superior mesenteric artery syndrome — A condi- 
tion in which a person vomits after meals due to 
blockage of the blood supply to the intestine. 

for anorexia is estimated at around 10%, although some 
studies give a lower figure of 3-4%. The most frequent 
causes of death associated with anorexia are starvation, 
electrolyte imbalance, heart failure, and suicide. 


Short of major long-term changes in the larger soci- 
ety, the best strategy for prevention of anorexia is the 
cultivation of healthy attitudes toward food, weight con- 
trol, and beauty (or body image) within families. 



"Anorexia Nervosa.” In Diagnostic and Statistical Manual of 
Mental Disorders, Fourth Edition. Washington, DC: The 
American Psychiatric Association, 1994. 

Baron, Robert B. “Nutrition.” In Current Medical Diagnosis & 
Treatment edited by Lawrence M. Tierney, Jr., et al. Stam- 
ford, CT: Appleton & Lange, 1998. 

The Burton Goldberg Group. Alternative Medicine: The Defin- 
itive Guide. Fife, WA: Future Medicine Publishing, 1995. 
Cassell, Dana K., with Felix E. F. Larocca. The Encyclopedia 
of Obesity and Eating Disorders. New York: Facts on File, 
Inc., 1994. 


Anorexia nervosa 

Anthroposophical medicine 

Herzog, David B. “Eating Disorders.” In The New Harvard 
Guide to Psychiatry. Edited by Armand M. Nicholi, Jr., 
Cambridge, MA, and London, UK: The Belknap Press of 
Harvard University Press, 1988. 

Kaplan, David W., and Kathleen A. Mammel. “Adolescence.” 
In Current Pediatric Diagnosis & Treatment. Edited by 
William W. Hay, Jr., et al. Stamford, CT: Appleton & 
Lange, 1997. 

Mitchell, James E. “Anorexia Nervosa: Medical and Physiolog- 
ical Aspects.” In Handbook of Eating Disorders. Edited 
by Kelly D. Brownell and John P. Foreyt. New York: Basic 
Books, Inc., 1986. 

The Medical Advisor: The Complete Guide to Alternative & 
Conventional Treatments. Richmond, VA: TimeLife Edu- 
cation, 1997. 

“Physical Conditions in Adolescence: Anorexia Nervosa.” In 
The Merck Manual of Diagnosis and Therapy, vol. II. 
Edited by Robert Berkow, et al. Rahway, NJ: Merck Re- 
search Laboratories, 1992. 

Pipher, Mary. Reviving Ophelia: Saving the Selves of Adoles- 
cent Girls. New York: Ballantine Books, 1994. 


American Anorexia/Bulimia Association. 418 East 76th St., 
New York, NY 10021. (212) 734-1114. 

National Institute of Mental Health Eating Disorders Program, 
Building 10, Room 3S231. 9000 Rockville Pike, Bethes- 
da, MD 20892. (301) 496-1891. 


Eating Disorders Home Page, < 

Mai Tran 

Anthroposophical medicine 


Anthroposophical medicine (AM), or anthroposophi- 
cally extended medicine, is a system of healing based on 
the spiritual science that was developed by Rudolph Steiner. 


Rudolph Steiner (1861-1925) was a philosopher and 
teacher who founded anthroposophy ( anthropos meaning 
human and sophy meaning wisdom), which is a worldwide 
spiritual movement that seeks to apply a scientific ap- 
proach to spiritual perception. Steiner, from Austria, be- 
lieved that everyone has spiritual powers that can be acti- 
vated by exercises in mental concentration and 
meditation. During his lifetime, he was an active teacher, 
attracting many followers to his spiritual ideas. Steiner 


founded several schools, wrote nearly 30 books, and gave 
more than 6,000 lectures around the world on subjects in- 
cluding education, medicine, agriculture, social issues, sci- 
ence and art. His ideas have remained influential. The Wal- 
dorf school system, which he began, educates thousands of 
young people each year. Many health food stores carry 
products produced by Steiner’s system of agriculture called 
biodynamic farming, which considers the health and purity 
of the soil, water, and air to be of central importance. 

Anthroposophical medicine is based on Steiner’s 
concept that spiritual awareness is the foundation of in- 
dividual health and of the health of society. Steiner be- 
lieved that many of the oldest systems of healing, such as 
traditional Chinese medicine. Ayurvedic medicine, 
and Tibetan medicine, were based on a spiritual percep- 
tion of the world that modern science has lost. Steiner 
wanted medicine to get back in touch with spirituality, 
and at the same time keep and use wisely the gains that 
science and technology have made. Thus, conventional 
medicine needed to be extended beyond physical science 
to include a holistic spiritual science. 

Steiner formally began application of his philosophy 
in a series of 20 lectures in the early spring of 1920 to 
the medical community of a town in Switzerland. It was 
the first such course for physicians and medical students. 
He and Dutch medical doctor Ita Wegman co-authored a 
foundational work for physicians wanting to expand 
their practice according to anthroposophic principles. 

Anthroposophical medicine is still in its early stages. 
Steiner believed that it would take many years for his med- 
ical ideas to be fully applied. There are thousands of anthro- 
posophical doctors and researchers practicing in Europe, 
where the main school was founded. In America, practition- 
ers can be found in several large cities, but the overall num- 
ber of anthroposophical physicians is very small. 


Anthroposophical medicine can be used to treat any 
health condition. It is particularly recommended for pre- 
ventive care, infections, inflammatory conditions such 
as arthritis, and the treatment of cancer and chronic de- 
generative diseases associated with aging. It is also rec- 
ommended for pediatric (child) care, with its avoidance 
of toxic drugs, and is beneficial for children’s conditions 
such as attention-deficit hyperactivity disorder 
(ADHD) and developmental problems. 


The anthroposophical concept of the body 

Anthroposophical physicians have a different view 
of the body and health than the conventional scientific 


model. Human beings are made up of four levels (“four- 
foldness”) of being. The first level is the physical body. 
The second level is the life or etheric body, which corre- 
sponds to the Chinese idea of chi and the Ayurvedic idea 
of prana. The third level is the soul, or astral body, and 
the fourth level is the spirit. AM doctors believe that all 
levels of being influence a patient’s health. 

The physical body is made up of a three-fold sys- 
tem, including the “sense-nerve” system that comprises 
the head and nervous system, supporting the mind and 
the thinking process. Second is the “metabolic-limb” 
system that includes the digestive system for elimina- 
tion, energetic metabolism, and voluntary movement 
processes, all supporting aspects of human behavior that 
express the will. Finally, the rhythmic system that in- 
cludes the heart and lungs in the chest, is responsible for 
balancing the head and digestive systems. According to 
AM, these systems tend to oppose each other in func- 
tioning and characteristics, similar to the Chinese con- 
cept of yin and yang. For instance, the digestive system 
is associated with heat and helps to dissolve elements in 
the body, while the head system is associated with cool- 
ing and helps in the formation of elements in the body. 
Illness is caused when the systems of the body become 
out of balance. AM involves a broad understanding of 
the three bodily systems, and the illnesses associated 
with each system and its imbalance. This model provides 
practitioners a means for therapeutic insight now recog- 
nized as mind-body relationships in health and disease. 

In anthroposophical medicine, illness is considered a 
significant event in a person’s life, and not just a chance 
occurrence. One role of the doctor is to understand, and 
help the patient understand, the significance of the illness 
on all levels of being. Conventional medicine tends to 
suppress illness, using drugs to block the symptoms. AM 
doctors believe that true healing must first bring an illness 
out in order to heal it, and that healing requires change 
and development in the patient on several levels. 

AM also asserts, as did the early healer Paracelsus, 
that every illness has a cure that can be found in nature. 
Paracelsus is the pseudonym for a Swiss-born alchemist 
and physician who lived from 1493-1541. Nature and 
the human body are made up of the plant, animal, and 
mineral kingdoms, and thus AM doctors use medicines 
that are made from plants, animals (usually in the form 
of organ extracts), and minerals. AM remedies are usual- 
ly given in homeopathic doses, which are very diluted, 
non-toxic solutions. 

Treatment by an anthroposophical physician 

All anthroposophical physicians are conventionally 
trained M.D.s, as Steiner believed that conventional train- 


ing was a necessary first step. However, a visit to an an- 
throposophical physician may be different than a visit to a 
regular doctor. Anthroposophical doctors, first of all, tend 
to spend much more time with their patients, particularly 
during the initial visit. Every patient is considered unique, 
and AM doctors use the first visit to get a broad under- 
standing of patients and their medical histories. To diag- 
nose illnesses, AM doctors may use modern diagnostic 
tools, but also rely on intuition and an understanding of the 
patient. Part of training of AM doctors involves improving 
their powers of perception in order to understand illnesses. 
Diagnosis is considered a very important process; Steiner 
believed that if the diagnosis of a problem is done correct- 
ly, then the therapeutic (healing) work is much easier. After 
a problem is thoroughly diagnosed, treatment will be rec- 
ommended. AM doctors attempt to treat a patient on all 
four levels of being. For the physical body, remedies will 
be prescribed. There are hundreds of uniquely formulated 
medications, similar to homeopathies, as well as botanical 
medicines. AM doctors try to minimize the use of antibi- 
otics, drugs, and vaccinations. 

Anthroposophical medicine also uses allied thera- 
pies, which are additional therapies that Steiner recom- 
mended to heal patients on other levels than the physical. 
These include massage therapy and a movement thera- 
py called eurythmy. Eurythmy is a system of movements 
designed to help patients give expression to inner spiritu- 
al movements. Psychotherapy may also be recommend- 
ed to help heal some conditions. AM doctors may apply 
allied therapies themselves, or refer patients to other 
healers. The length of treatment with AM depends on the 
patient and condition. The cost of treatment varies with 
the practitioner, and is comparable to treatment by con- 
ventional M.D.s. AM medications are less expensive 
than conventional drugs. Because AM practitioners are 
trained medical doctors, insurance policies often cover 
their fees, although consumers should be aware of their 
policy restrictions. 


AM doctors may give new patients packages of ma- 
terials before treatment, which include thorough ques- 
tionnaires and explanations of AM. Anthroposophical 
physicians encourage patients to prepare for treatment 
by becoming willing to take responsibility for their con- 
dition and health, and to change their behaviors and 
lifestyles in the interest of healing. 

Side effects 

AM medications are safe and non-toxic. During 
treatment, some patients may experience what doctors 
call “healing crises.” During these, patients may tem- 


Anthroposophical medicine 



Ayurvedic medicine — System of healing originat- 
ing in ancient India. 

Chi — Universal life energy as defined by tradition- 
al Chinese medicine. Also known as qi. 

Homeopathy — System of healing using minute, di- 
luted doses of remedies that would otherwise pro- 
duce symptoms of the treated disease. Prepared 
from plant, animal, mineral and human sources, 
they are tailored for individualized treatment. 

Yin and yang — Two opposite and complimentary 
characteristics used to describe the universe and 
phenomena, defined by traditional Chinese medi- 

porarily experience a worsening of symptoms as part of 
the healing process, including fever, headaches, nausea, 
weakness, muscle soreness, and other symptoms. 

Research & general acceptance 

Active research in AM is being regularly conducted 
in Europe, mainly in Germany, Holland, Switzerland, and 
France. Several research organizations performing patient- 
centered research have shown promising results with the 
AM cure for cancer, which utilizes the herbal remedy 
mistletoe extract, and for other conditions. Other research 
has shown that AM is less expensive than conventional 
medical treatment, with 50% fewer illness days than when 
treated by conventional practitioners. Current research 
studies appear in the quarterly Journal of Anthroposophi- 
cal Medicine , as well as in European publications. 

Training & certification 

Currently, there is no course for the certification of 
AM practitioners, although every AM doctor is required 
to obtain training as a certified M.D. Afterwards, physi- 
cians may specialize in AM by taking a series of courses 
or by interning with specialists. The Physicians Associa- 
tion for Anthroposophic Medicine (PAAM) is the largest 
association in North America. The organization for non- 
M.D. health professionals interested in anthroposophical 
medicine is Artemesia, The Association for Anthropo- 
sophical Renewal of Healing. 



Bott, Victor. Anthroposophical Medicine. Hudson, New York: 

Anthroposophic Press, 1985. 


Steiner, Rudolph. Introducing Anthroposophic Medicine. Hud- 
son, New York: Anthroposophical Press, 1998. 


Anthroposophic Press. RR 4 Box 94 A-l. Hudson, NY 518- 

Artemesia, The Association for Anthroposophical Renewal of 
Healing. 1923 Geddes Avenue, Ann Arbor, MI 48104, 
(734) 930-9462. 

Gilpen Street Holistic Center. Dr. Philip Incao, M.D., 1624 
Gilpen Street, Denver, CO 80218, (303) 321-2100. 

Physicians Association for Anthroposophic Medicine (PAAM). 
1923 Geddes Avenue. Ann Arbor, MI 48104, (734) 930- 

Douglas Dupler 



Antioxidants are a broad group of compounds that 
destroy single oxygen molecules, also called free radi- 
cals, in the body, thereby protecting against oxidative 
damage to cells. They are essential to good health and 
are found naturally in a wide variety of foods and plants, 
including many fruits and vegetables. Many antioxi- 
dants, either singly or in combination, are also available 
as over-the-counter nutritional supplements in tablet or 
capsule form. The most commonly used antioxidants are 
vitamin C, vitamin E, and beta carotene. Others in- 
clude grape seed extract, vitamin A, selenium, and 
coenzyme Q 10 . It is unknown whether or not supplemen- 
tal antioxidants provide the same benefits as those occur- 
ring naturally in foods, however. 

General use 

In brief, antioxidants destroy free radicals in the 
body. Free radicals are byproducts of oxygen metabo- 
lism that can damage cells and are among the causes of 
many degenerative diseases, especially diseases associat- 
ed with aging. They are also associated with the aging 
process itself. As a person ages, cell damage accumu- 
lates, and supplementing the diet with extra antioxidant- 
rich foods can help slow the oxidative damage done to 
cells. Scientific studies validate the role of antioxidants 
in preventing many diseases. Although studies have 
shown lower rates of cancer and heart disease in people 
who eat a recommended amount of fruits and vegetables, 
recent clinical studies have shown that supplementation 


of diet with antioxidant vitamin therapy does not lower 
risk of cardiovascular disease or certain other diseases. 

Many herbs and medicinal plants are good natural 
sources of antioxidants. These include carrots, tomatoes, 
yams, leafy greens, blueberries, billberries, ginkgo bilo- 
ba, garlic, and green tea, to name a few. A diet rich in 
vitamin C, vitamin E, and beta carotene may help reduce 
the risk of some cancers, heart disease, cataracts, and 

Vitamin A 

A study by the University of Arizona found that vita- 
min A has a protective affect against many types of cancer, 
according to Dr. Michael Colgan in his book, The New 
Nutrition. Vitamin A is a fat-soluble antioxidant found in 
animal products but can be made by the body from its pre- 
cursor, beta carotene. Foods rich in vitamin A are liver, 
eggs, and fortified dairy products. Vitamin A helps bones 
and teeth develop, and promotes vision. As an antioxidant, 
it protects cell membranes and fatty tissue, helps repair 
damage caused by air pollutants, and boosts the immune 
system. A deficiency of this vitamin can result in dry skin, 
brittle hair, vision problems, blindness, and increased sus- 
ceptibility to respiratory infections. 

Vitamin C 

Probably the most widely used of all vitamin supple- 
ments, vitamin C is a powerful antioxidant that has a myr- 
iad of functions and helps strengthen the immune system. 
It became famous in the 1970s when Nobel Prize-winning 
scientist Linus Pauling advocated daily mega doses (8-10 
grams) of vitamin C to prevent and ease the symptoms of 
the common cold. Many clinical studies that show vita- 
min C is superior to over-the-counter medicines in reduc- 
ing the symptoms, duration, and severity of colds. As an 
antioxidant, vitamin C may help fight cardiovascular dis- 
ease by protecting the linings of arteries from oxidative 
damage. In 2002, debate still continued on the vitamin’s 
effects on heart disease. One study revealed that Vitamins 
C and E helped reduce arteriosclerosis (hardening of the 
arteries) following heart transplants. Yet another study 
demonstrated that vitamin therapy had not effect on pre- 
venting heart disease. There is some evidence and re- 
search that vitamin C can help prevent cancer. Studies 
have shown it is also beneficial in protecting the body 
against the effects of smoking and air pollutants. 

Vitamin E 

Vitamin E is a potent antioxidant by itself, but its ef- 
fectiveness is magnified when taken with other antioxi- 
dants, especially vitamin C, selenium, and beta carotene. 
Some scientific evidence indicates that vitamin E helps 


promote cardiovascular health. Past studies have demon- 
strated higher vitamin E intake is associated with de- 
creased incidence of heart disease in both men and women. 
In fact, the combination of Vitamin C and E can slow pro- 
gression of cardiovascular disease following heart trans- 
plant. In 2002, researchers stated that the vitamin combina- 
tion might also be useful in other organ transplants. In ad- 
dition, Harvard Medical School reported in the same year 
that Vitamin E might play a role in helping people live 
longer, citing its role in strengthening the immune system. 


This class of antioxidants includes beta carotene, 
lutein, and lycopene. They are found in a variety of 
fruits and vegetables such as carrots, pumpkins, kale, 
spinach, tomatoes, and pink grapefruit. Research evi- 
dence suggests carotenoids lower the risk of heart dis- 
ease and some types of cancer, and strengthen the im- 
mune system. Lycopene, which is concentrated in the 
prostate gland, is believed to protect the prostate from 
cancer. Lutein is thought to prevent macular degenera- 
tion, a major cause of blindness, or stop its progression. 
Beta carotene increases the lungs’ defense system in 
smokers or those exposed to other air-borne pollutants. It 
also has been used as an immune system stimulator in 
people with AIDS. In 2002, a report revealed that more 
than 90% of ophthalmologists and optometrists surveyed 
believe that lutein helps prevent eye disease. 


Bioflavonoids are a group of about 5,000 com- 
pounds that act as antioxidants. They occur in fruits, veg- 
etables, green tea, soy products, herbs, and spices. A 
combination of bioflavonoids has a synergistic effect 
when taken with vitamin C. They have been shown to be 
beneficial in treating a variety of conditions, including 
allergies, arthritis, diabetes, hypertension, and viral in- 
fections. One group of bioflavonoids found to be a pow- 
erful antioxidant is oligomeric proanthocyanidins 
(OPCs), also known generically as pycnogenol. Ex- 
tremely high concentrations of OPCs are found in mar- 
itime pine bark ( Finns maritima) extract, grape seed ex- 
tract, and grape and peanut skins. Due primarily to its 
much lower cost, grape seed extract is the most com- 
monly used OPC. Procyanidins, a group of compounds 
found in the extract, are thought to increase the effective- 
ness of other antioxidants, especially vitamin C and vita- 
min E, by helping them regenerate after neutralizing free 
radicals in the blood and tissue. 

Other antioxidants 

The other widely used antioxidants are selenium, coen- 
zyme Q 10 , and certain amino acids. Selenium, especially 




when teamed with vitamin E, may help protect against 
lung, colon, prostate, and rectum cancers. The antioxidant 
benefits of coenzyme Q 10 may include slowing the aging 
process, boosting the immune system, and preventing ox- 
idative damage to the brain. Some still suggest its use to 
treat a variety of cardiovascular diseases. Amino acids that 
have strong antioxidant effects include alpha lipoic acid, 
cysteine, glutathione, and N-acetyl cysteine (NAC). 


Bottled antioxidant formulae are available in a single 
pill or as part of a multivitamin. The usual dosages of an- 
tioxidants taken individually can vary widely. The United 
States Department of Agriculture (USDA) has established 
recommended daily allowance, but these may be conserv- 
ative amounts for preventing diseases. For instance, the 
USDA recommendation for vitamin C is 60 mg a day but 
natural healthcare practitioners commonly recommend 
500 mg a day or more. The dosage may also depend on 
whether it is being taken to treat or prevent a specific con- 
dition. With that in mind, the common daily dosages for 
specific antioxidants are: vitamin A, 5,000-15,000 IU; 
beta carotene, 15,000-25,000 IU; vitamin C, 250-1,500 
mg; vitamin E, 30-400 IU; selenium, 50-400 micrograms; 
bioflavonoids, 100-500 mg; grape seed extract, 150-200 
mg; coenzyme Q 10 , 90-150 mg; alpha lipoic acid, 20-50 
mg or 300-600 mg for elevated blood sugar levels; glu- 
tathione, 100 mg; N-acetyl cysteine, 600 mg. 


Vitamin C: May interfere with some laboratory tests, 
including urinary sugar spilling for diabetics. Vitamin A: 
Can be toxic in high doses of more than 15,000 IU per day 
or chronic doses for months, and may cause birth defects if 
taken in high doses during pregnancy. In 2002, one study 
showed that consistent Vitamin A intake could increase the 
risk of hip fractures in postmenopausal women, but the 
study was not representative of all women, and more study 
on the upper limits of safe Vitamin A consumption for 
women in their 40s and 50s is needed. Vitamin E: Danger- 
ous in very high doses. Carotenoids: No known precau- 
tions are indicated for normal doses. Bioflavonoids: No 
known precautions are indicated for normal doses. Seleni- 
um: No precautions indicated at normal doses, but a physi- 
cian should be consulted before taking daily doses of more 
than 200 micrograms. Coenzyme Q 10 : No known precau- 
tions are indicated for normal dosage. Amino acids: There 
are no known precautions indicated for alpha lipoic acid, 
cysteine, glutathione, or NAC. 

Side effects 

Vitamin C: Individual tolerances vary. High doses 
may cause cramps, diarrhea, ulcer flare-ups, kidney 


stones, and gout in some people. Vitamin A: High doses 
can lead to headaches, nausea, hair loss, and skin le- 
sions; may cause bone disease in people with chronic 
kidney failure. Vitamin E: Usually no adverse side ef- 
fects in doses of up to 400 mg a day, high doses may ele- 
vate blood pressure and lead to blood-clotting problems. 
Carotenoids: No known side effects occur with normal 
dosage. Bioflavonoids: No known negative side effects 
in normal doses. Selenium: No reported adverse side ef- 
fects with normal dosage of 200 micrograms, higher 
doses may cause dizziness and nausea. Coenzyme Q 10 : 
No adverse side effects have been reported. Amino acids: 
There are no known side effects associated with normal 
doses of alpha lipoic acid, cysteine, glutathione, or NAC. 


Vitamin C: No known common adverse interactions 
with other drugs. Vitamin A: Women taking birth control 
pills should consult with their doctors before taking extra 
vitamin A. Vitamin E: Should not be used by persons 
taking anti-coagulation drugs. Carotenoids: No known 
negative interactions with other drugs. Bioflavonoids: 
No known adverse interactions with other drugs. Coen- 
zyme Q 10 : No negative drug interactions yet reported. 
Amino acids: There are no adverse reactions yet reported 
between alpha lipoic acid, cysteine, glutathione, or NAC 
and other medications. 



Balch, Dr. James F. The Super Antioxidants: Why They Will 
Change the Face of Health Care in the 21st Century. M. 
Evans and Co., 1998. 

Colgan, Dr. Michael. The New Nutrition. Cl Publications, 

Challem, Jack, editor. All About Antioxidants. Avery Publishing 
Group, 1999. 

Hendler, Dr. Sheldon Saul The Doctors' Vitamin and Mineral 
Encyclopedia. Simon and Shuster, 1990. 

Moss, Ralph W. Antioxidants Against Cancer. Equinox Press, 
2000 . 

Murray, Michael T. Natural Alternatives to Over-the-Counter 
and Prescription Drugs. William Morrow and Co., 1994. 
Packer, Lester, et al. The Antioxidant Miracle: Your Complete 
Plan For Total Health and Healing. John Wiley and Sons, 

Smythies, John R. Every Person's Guide to Antioxidants Rut- 
gers University Press, 1998. 


Abramowiez, Dr. Mark, editor. “Vitamin Supplements.” The 
Medical Letter ( July 31, 1998): 75- 77. 

“Antioxidant Vitamin E Reported to Strengthen Immune Sys- 
tem.” Obesity, Fitness & Wellness Week (March 2, 2002): 
12 . 



Atherosclerosis — A buildup of fatty substances in 
the inside of arteries, resulting in the restriction of 
blood flow and hardening of the vessels. 

Macular degeneration — An eye disease resulting 
in a loss of central vision in both eyes while pe- 
ripheral vision is preserved. 

Oxidation — The loss of electrons from a molecule 
by their bonding to an oxygen molecule, render- 
ing the donor molecule positive in charge and the 
recipient oxygen negative in charge (free radical). 
Sinusitis — An inflammation or infection in the 
sinus cavities in the head. 

Fang, James C., et al. “Effect of Vitamins C and E on Progres- 
sion of Transplant- Associated Arteriosclerosis: A random- 
ized Trial.” The Lancet (March 30, 2002): 1108. 

Kiningham, Robert.“The Value of Antioxidant Vitamin Supple- 
ments.” American Family Physician (Sept. 1, 1999): 742. 

Koch Kubetin, Sally. “Antioxidants Fall Short.” OB GYN News 
(February 1, 2002): 29. 

Langer, Stephen. “Antioxidants: Our Knights in Shining 
Armor.” Better Nutrition (May 1997): 46- 50. 

"Lutein Helps Protect Eyes, Doctors Say in Survey.” Ophthal- 
mology Times (March 15, 2002): 29. 

Raloff, Janet. “The Heart-Healthy Side of Lycopene.” Science 
News (Nov. 29, 1997): 348. 

Scheer, James F. "Twelve Key Antioxidants: May Their Force 
Be With You.” Better Nutrition (Jan. 1999): 58. 

Schindler, Martha.“The Magnificent Seven.” Vegetarian Times 
(Feb. 1999): 86. 

“Simvastatin Yes, Antioxidant No n Two Important New Stud- 
ies.” Clinical Cardiology Alert (January 2002): 1. 

Tyler, Varro E.“The Miracle of Anti- Aging Herbs.” Prevention 
(Nov. 1999): 105. 

“Vitamin A Intake Levels Reaffirmed as Safe and Beneficial.” 
Medical Letter on the CDC & FDA (January 27, 2002): 14. 

Ken R. Wells 
Teresa G. Odle 



Anxiety is a bodily response to a perceived threat or 
danger. It is triggered by a combination of biochemical 
changes in the body, the patient's personal history and 
memory, and the social situation. 


It is important to distinguish between anxiety as a 
feeling or experience and an anxiety disorder as a psy- 
chiatric diagnosis. A person may feel anxious without 
having an anxiety disorder. Also, a person facing a clear 
and present danger or a realistic fear is not usually con- 
sidered to be in a state of anxiety. In addition, anxiety 
frequently occurs as a symptom in other categories of 
psychiatric disturbance. 


Anxiety is related to fear, but it is not the same 
thing. Fear is a direct, focused response to a specific 
event or object of which an individual is consciously 
aware. Most people will feel fear if someone points a 
loaded gun at them or if they see a tornado forming on 
the horizon. They also will recognize that they are afraid. 
Anxiety, on the other hand, is often unfocused, vague, 
and hard to pin down to a specific cause. 

Sometimes anxiety experienced in the present may 
stem from an event or person that produced pain and 
fear in the past. In this experience, the anxious individual 
may not be consciously aware of the original source of 
the feeling. Anxiety has an aspect of remoteness that 
makes it hard for people to compare their experiences. 
Whereas most people will be fearful in physically dan- 
gerous situations, and can agree that fear is an appropri- 
ate response in the presence of danger, anxiety is often 
triggered by objects or events that are unique and specif- 
ic to an individual. An individual might be anxious be- 
cause of a unique meaning or memory being stimulated 
by present circumstances, not because of some immedi- 
ate danger. 

Causes & symptoms 

Anxiety is characterized by the following symp- 

• Somatic. These physical symptoms include headaches, 
dizziness or lightheadedness, nausea and/or vomiting, 
diarrhea, tingling, pale complexion, sweating, numb- 
ness, difficulty in breathing, and sensations of tightness 
in the chest, neck, shoulders, or hands. These symptoms 
are produced by the hormonal, muscular, and cardiovas- 
cular reactions involved in the fight-or-flight reaction. 

• Behavioral. Behavioral symptoms of anxiety include 
pacing, trembling, general restlessness, hyperventilation, 
pressured speech, hand wringing, and finger tapping. 

• Cognitive. Cognitive symptoms of anxiety include re- 
current or obsessive thoughts, feelings of doom, mor- 
bid or fear-inducing thoughts or ideas, and confusion or 
inability to concentrate. 




• Emotional. Emotional symptoms include feelings of 
tension or nervousness, feeling “hyper” or “keyed up,” 
and feelings of unreality, panic, or terror. 

Anxiety can have a number of different causes. It is 
a multidimensional response to stimuli in the person’s 
environment, or a response to an internal stimulus (for 
example, a hypochondriac’s reaction to a stomach rum- 
bling) resulting from a combination of general biological 
and individual psychological processes. 

Physical triggers 

In some cases, anxiety is produced by physical re- 
sponses to stress or by certain disease processes or med- 

vous system of human beings is hard-wired to respond to 
dangers or threats. These responses are not subject to 
conscious control and are the same in humans as in 
lower animals. They represent an evolutionary adapta- 
tion to animal predators and other dangers that all ani- 
mals — including primitive humans — had to cope with. 

The most familiar reaction of this type is the fight- 
or-flight reaction to a life-threatening situation. When 
people have fight-or-flight reactions, the level of stress 
hormones in their blood rises. They become more alert 
and attentive, their eyes dilate, their heartbeats increase, 
their breathing rates increase, and their digestion slows 
down, making more energy available to the muscles. 

This emergency reaction is regulated by a part of the 
nervous system called the autonomic nervous system, or 
ANS. The ANS is controlled by the hypothalamus, a spe- 
cialized part of the brainstem that is among a group of 
structures called the limbic system. The limbic system 
controls human emotions through its connections to 
glands and muscles; it also connects to the ANS and 
higher brain centers, such as parts of the cerebral cortex. 

One problem with this arrangement is that the lim- 
bic system cannot tell the difference between a real 
physical threat and an anxiety-producing thought or idea. 
The hypothalamus may trigger the release of stress hor- 
mones from the pituitary gland even when there is no ex- 
ternal danger. 

A second problem is caused by the biochemical side 
effects of too many false alarms in the ANS. When a per- 
son responds to a real danger, his or her body relieves it- 
self of the stress hormones by facing up to the danger or 
fleeing from it. In modern life, however, people often 
have fight-or-flight reactions in situations where they can 
neither run away nor lash out physically. As a result, their 
bodies have to absorb all the biochemical changes of hy- 
perarousal rather than release them. These biochemical 


changes can produce anxious feelings as well as muscle 
tension and other physical symptoms of anxiety. 

DISEASES AND DISORDERS. Anxiety can be a symp- 
tom of certain medical conditions. For example, anxiety 
is a symptom of certain endocrine disorders that are 
characterized by overactivity or underactivity of the thy- 
roid gland. Cushing’s syndrome, in which the adrenal 
cortex overproduces cortisol, is one such disorder. Other 
medical conditions that can produce anxiety include res- 
piratory distress syndrome, mitral valve prolapse, por- 
phyria, and chest pain caused by inadequate blood sup- 
ply to the heart (angina pectoris). 

medications may cause anxiety-like symptoms as a side 
effect. They include birth control pills, some thyroid or 
asthma drugs, some psychotropic agents, corticos- 
teroids, antihypertensive drugs, nonsteroidal anti-inflam- 
matory drugs (such as flurbiprofen and ibuprofen), and 
local anesthetics. Caffeine can also cause anxiety-like 
symptoms when consumed in sufficient quantity. 

Withdrawal from certain prescription drugs — pri- 
marily beta-blockers and corticosteroids — can cause anx- 
iety. Withdrawal from drugs of abuse, including LSD, co- 
caine, alcohol, and opiates, can also cause anxiety. 

Childhood development and anxiety 

Researchers in early childhood development regard 
anxiety in adult life as a residue of childhood memories 
of dependency. Humans learn during the first year of life 
that they are not self-sufficient and that their basic sur- 
vival depends on others. It is thought that this early expe- 
rience of helplessness underlies the most common anxi- 
eties of adult life, including fear of powerlessness and 
fear of not being loved. Thus, adults can be made anx- 
ious by symbolic threats to their sense of competence or 
significant relationships, even though they are no longer 
helpless children. 


The psychoanalytic model gives a lot of weight to 
the symbolic aspect of human anxiety; examples include 
phobic disorders, obsessions, compulsions, and other 
forms of anxiety that are highly individualized. Because 
humans mature slowly, children and adolescents have 
many opportunities to connect their negative experiences 
to specific objects or events that can trigger anxious feel- 
ings in later life. For example, a person who was fright- 
ened as a child by a tall man wearing glasses may feel 
panicky years later, without consciously knowing why, by 
something that reminds him of that person or experience. 

Freud thought that anxiety results from a person’s in- 
ternal conflicts. According to his theory, people feel anx- 


ious when they feel tom between moral restrictions and 
desires or urges toward certain actions. In some cases, the 
person’s anxiety may attach itself to an object that repre- 
sents the inner conflict. For example, someone who feels 
anxious around money may be pulled between a desire to 
steal and the belief that stealing is wrong. Money be- 
comes a symbol for the inner conflict between doing 
what is considered right and doing what one wants. 


Phobias are a special type of anxiety reaction in 
which the person concentrates his or her anxiety on a 
specific object or situation and then tries to avoid. In 
most cases, the person’s fear is out of proportion to its 
“cause.” It is estimated that 10-11% of the population 
will develop a phobia in their lifetime. Some phobias — 
agoraphobia (fear of open spaces), claustrophobia (fear 
of small or confined spaces), and social phobia, for ex- 
ample — are shared by large numbers of people. Others 
are less common or are unique to the patient. 

Social and environmental stressors 

Because humans are social creatures, anxiety often 
has a social dimension. People frequently report feelings 
of high anxiety when they anticipate or fear the loss of 
social approval or love. Social phobia is a specific anxi- 
ety disorder that is marked by high levels of anxiety or 
fear of embarrassment in social situations. 

Another social stressor is prejudice. People who be- 
long to groups that are targets of bias have a higher risk 
of developing anxiety disorders. Some experts think, for 
example, that the higher rates of phobias and panic dis- 
order among women reflects their greater social and 
economic vulnerability. 

Several controversial studies indicate that the in- 
crease in violent or upsetting pictures and stories in news 
reports and entertainment may raise people’s anxiety lev- 
els. Stress and anxiety management programs often rec- 
ommend that patients cut down their exposure to upset- 
ting stimuli. 

Environmental or occupational factors can also 
cause anxiety. People who must live or work around sud- 
den or loud noises, bright or flashing lights, chemical va- 
pors, or similar nuisances that they cannot avoid or con- 
trol may develop heightened anxiety levels. 


Diagnosing anxiety is difficult and complex because 
of the variety of possible causes and because each per- 
son’s symptoms arise from highly personalized and indi- 
vidualized experiences. When a doctor examines an anx- 


ious patient, he or she will first rule out physical condi- 
tions and diseases that have anxiety as a symptom. The 
doctor will then take the patient’s history to see if pre- 
scription drugs, alcohol or drug abuse, caffeine, work en- 
vironment, or other external stressors could be triggering 
the anxiety. In most cases, the most important source of 
diagnostic information is the patient’s psychological and 
social history. The doctor may administer several brief 
psychological tests, including the Hamilton Anxiety Scale 
and the Anxiety Disorders Interview Schedule (ADIS). 


Meditation and mindfulness training can benefit 
patients with phobias and panic disorder. Hydrother- 
apy, massage therapy, and aromatherapy are useful to 
some anxious patients because they can promote general 
relaxation of the nervous system. Essential oils of 
lavender, chamomile, neroli, sweet marjoram, and 
ylang-ylang are commonly recommended by aromather- 
apists for stress relief and anxiety reduction. 

Relaxation training, which is sometimes called anxi- 
ety management training, includes breathing exercises 
and similar techniques intended to help the patient pre- 
vent hyperventilation and relieve the muscle tension as- 
sociated with the fight-or-flight reaction. Yoga, aikido, 
tai chi, and dance therapy help patients work with the 
physical, as well as the emotional, tensions that either 
promote anxiety or are created by the anxiety. 

Homeopathy and traditional Chinese medicine 

(TCM) approach anxiety as a symptom of a holistic im- 
balance. Homeopathic practitioners select a remedy based 
on other associated symptoms and the patient’s general 
constitution. Homeopathic remedies for anxiety include 
ignatia, gelsemium, aconite, pulsatilla, arsenicum 
album, and coffea cruda. These remedies should be pre- 
scribed by a homeopathic healthcare professional. 

Chinese medicine regards anxiety as a disruption of qi , 
or energy flow, inside the patient’s body. Acupuncture 
and/or herbal therapy are standard remedies for rebalancing 
the entire system. Reishi ( Ganoderma lucidum or Ling-Zhi) 
is a medicinal mushroom prescribed in TCM to reduce anx- 
iety and insomnia. However, because reishi can interact 
with other prescription drugs and is not recommended for 
patients with certain medical conditions, individuals should 
consult their healthcare practitioner before taking the reme- 
dy. Other TCM herbal remedies for anxiety include the 
cordyceps mushroom (also known as catepillar fungus) 
and Chinese green tea. In addition, there are numerous 
TCM formulas that combine multiple herbs for use as an 
anxiety treatment, depending on the individual problem. 

Herbs known as adaptogens may also be prescribed 
by herbalists or holistic healthcare providers to treat anxi- 




ety. These herbs are thought to promote adaptability to 
stress, and include Siberian ginseng ( Eleutherococcus sen- 
ticosus), ginseng ( Panax ginseng ), wild yam (Dioscorea 
villosa), borage ( Borago officinalis), licorice ( Glycyrrhiza 
glabra), chamomile ( Chamaemelum nobile), milk thistle 
(Silybum marianum), and nettles ( Urtica dioica). Tonics 
of skullcap ( Scutellaria lateriafolia), and oats (Arena 
sativa), may also be recommended to ease anxiety. 

A 2002 preliminary study found that St. John’s wort 
could be an effective treatment for generalized anxiety. 
Patients taking 900 mg a day and higher doses responded 
well in early trials. However, further research was need- 
ed, particularly at doses higher than 900 mg per day. The 
Ayurvedic herb gotu kola, long used by practitioners of 
India’s holistic medical system to enhance memory and 
relieve varicose veins, may also help patients with anxi- 
ety by working against the startle response. 

Allopathic treatment 

Because anxiety often has more than one cause and 
is experienced in highly individual ways, its treatment 
often requires more than one type of therapy. In some 
cases, several types of treatment may need to be tried be- 
fore the best combination is discovered. It usually takes 
about six to eight weeks to evaluate the effectiveness of a 
treatment regimen. 


Medications are often prescribed to relieve the phys- 
ical and psychological symptoms of anxiety. Most med- 
ications work by counteracting the biochemical and 
muscular changes involved in the fight-or-flight reaction. 
Some work directly on the brain chemicals that are 
thought to underlie the anxiety. 

ANXIOLYTICS. Anxiolytics are sometimes called 
tranquilizers. Most anxiolytic drugs are either benzodi- 
azepines or barbiturates. However, barbiturates, once 
commonly used, are now rarely used in clinical practice. 
Benzodiazepines work by relaxing the skeletal muscles 
and calming the limbic system. They include such drugs 
as chlordiazepoxide (Librium) and diazepam (Valium). 
Both barbiturates and benzodiazepines are potentially 
habit-forming and may cause withdrawal symptoms, but 
benzodiazepines are far less likely than barbiturates to 
cause physical dependency. 

Two other types of anxiolytic medications include 
meprobamate (Equanil), which is now rarely used, and 
buspirone (BuSpar), a new type of anxiolytic that ap- 
pears to work by increasing the efficiency of the body’s 
own emotion-regulating brain chemicals. Unlike barbitu- 
rates and benzodiazepines, buspirone does not cause de- 


pendence problems, does not interact with alcohol, and 
does not affect the patient’s ability to drive or operate 
machinery. However, buspirone is not effective against 
certain types of anxiety, such as panic disorder. 

ment of choice for obsessive-compulsive disorder, 
panic type anxiety, and other anxiety disorders is a group 
of antidepressants known as selective serotonin reuptake 
inhibitors (SSRIs), such as Prozac and Paxil. When anxi- 
ety occurs in tandem with depressive symptoms, tricyclic 
antidepressants such as imipramine (Tofranil) or 
monoamine oxidase inhibitors (MAO inhibitors) such as 
phenelzine (Nardil) are sometimes prescribed. 

Beta-blockers are medications that work by block- 
ing the body's reaction to the stress hormones that are re- 
leased during the fight-or-flight reaction. They include 
drugs like propranolol (Inderal) or atenolol (Tenormin). 
Beta-blockers are sometimes given to patients with post- 
traumatic anxiety symptoms or social phobic anxiety. 


Most patients with anxiety will be given some form 
of psychotherapy along with medication. Many patients 
benefit from insight-oriented therapies, which are de- 
signed to help them uncover unconscious conflicts and 
defense mechanisms in order to understand how their 
symptoms developed. 

Cognitive-behavioral therapy (CBT) also works well 
with anxious patients. In CBT, the patient is taught to 
identify thoughts and situations that stimulate his or her 
anxiety, and to view them more realistically. In the be- 
havioral part of the program, the patient is exposed to the 
anxiety-provoking object, situation, or internal stimulus 
(like a rapid heart beat) in gradual stages until he or she 
is desensitized to it. 

Expected results 

Unfortunately, a 2002 report stated that about half of 
the patients with an anxiety disorder who see their pri- 
mary care physician go untreated. The prognosis for re- 
solving anxiety depends on the specific disorder and a 
wide variety of factors, including the patient’s age, gen- 
eral health, living situation, belief system, social support 
network, and responses to different medications and 
forms of therapy. 



“Anxiety Disorders.” In Diagnostic and Statistical Manual of 

Mental Disorders. 4th ed. Washington, DC: The American 

Psychiatric Association, 1994. 



Anxiolytic — A type of medication that helps to re- 
lieve anxiety. 

Aromatherapy — The therapeutic use of plant-de- 
rived, aromatic essential oils to promote physical 
and psychological well-being. 

Autonomic nervous system (ANS) — The part of 
the nervous system that supplies nerve endings in 
the blood vessels, heart, intestines, glands, and 
smooth muscles; it also governs their involuntary 
functioning. The autonomic nervous system is re- 
sponsible for the biochemical changes involved in 
experiences of anxiety. 

Endocrine gland — A ductless gland, such as the 
pituitary, thyroid, or adrenal gland, that secretes 
its products directly into the blood or lymph. 
Hyperarousal — A state or condition of muscular 
and emotional tension produced by hormones re- 
leased during the fight-or-flight reaction. 

Hypothalamus — A portion of the brain that regu- 
lates the autonomic nervous system, the release of 
hormones from the pituitary gland, sleep cycles, 
and body temperature. 

Limbic system — A group of structures in the brain 
that includes the hypothalamus, amygdala, and 
hippocampus. The limbic system plays an impor- 
tant part in regulation of human moods and emo- 

Phobia — In psychoanalytic theory, a psychologi- 
cal defense against anxiety in which the patient 
displaces anxious feelings onto an external object, 
activity, or situation. 

Bloomfield, Harold H. Healing Anxiety with Herbs. New York: 
HarperCollins, 1998. 

Corbman, Gene R. "Anxiety Disorders." In Current Diagnosis 
9, edited by Rex B. Conn, et al. Philadelphia: W. B. Saun- 
ders, 1997. 


Gaby, Alan R. “Consider St. John's Wort as Alternative to 
Kava. (Literature Review & Commentary).” Townsend 
Letter for Doctors and Patients (May 2002):34. 

Mandile, Maria Noel. “Gotu Kola: This Ayurvedic Herb May 
Reduce Your Anxiety Without the Side Effects of Drugs.” 
Natural Health (May-June 2002):34. 

Zoler. Michael L. “Anxiety Disorder Often Goes Untreated in 
Primary Care. (504 Patients in 15 Practices Studied).” 
Family Practice News (April 1, 2002): 14 -21. 



The American Botanical Council. P.O. Box 144345, Austin, 
Texas 78714-4345. (512) 926-4900. Fax: (512) 926-2345. 

Paula Ford-Martin 
Teresa G. Odle 



Not all products used in alternative healing come 
from plants. Apis mellifica is the venom of the common 
honeybee or a tincture made from the whole bee. Various 
species of honeybees found throughout the world are 
used for this remedy in homeopathic medicine. The rem- 
edy made from them is usually called apis. Other folk 
medicine traditions use additional bee-related substances 
in healing such as honey, beeswax, pollen, royal jelly, 
and propolis. 

General use 

Homeopathic medicine operates on the principle 
that “like heals like.” This means that a disease can be 
cured by treating it with products that produce the same 
symptoms as the disease. These products follow another 
homeopathic law, the Law of Infinitesimals. In opposi- 
tion to traditional medicine, the Law of Infinitesimals 
states that the lower a dose of curative, the more effec- 
tive it is. To make a homeopathic remedy, the curative is 
diluted many, many times until only a tiny amount re- 
mains in a huge amount of the diluting liquid. 

In homeopathic terminology, the effectiveness of 
remedies is “proved” by experimentation and reports by 
famous homeopathic practitioners. About 1900, both bee 
venom and tincture from the entire insect were proved as 
a remedy by the Central New York State Homeopathic 

In homeopathic medicine, apis is used as a remedy 
for many symptoms similar to those of bee stings. These 

• inflammation with a burning sensation 

• stinging pain 

• itchy skin 

• swollen and sensitive skin 

• red, flushed, hot face 

• hive-like welts on the skin 


Homeopathic practitioners use apis when stinging or 
burning inflammations appear in all parts of the body, 
not just on the skin. A homeopath could use apis for sore 
throats, mumps, urinary tract infections, and other con- 
ditions where there is a stinging or burning sensation. 

Symptoms treated by apis usually appear quite rapid- 
ly. There is usually some swelling or edema along with 
the stinging sensation. Many people who need apis com- 
plain of swollen eyelids, as if they had an eye infection. In 
keeping with the symptom of edema, often little urine is 
produced although there may be a strong urge to urinate. 
Despite this, the patient has little thirst or desire to drink. 

Often the patient who will be given apis appears 
flushed or has a rough rash. The rash may appear, then 
disappear. The skin will be sensitive to the touch and al- 
ternatively hot and dry, then sweaty. Patients may also 
feel nauseated, suffer from heartburn, or have tightness 
throughout their chest or abdomen that feels like they 
will burst if they cough or strain. 

Certain mental and emotional symptoms also appear 
in the patient that needs apis. Sadness, weeping, and de- 
pression can occur. Apis is often used after a person ex- 
periences a strong emotional reaction such as jealousy, 
fear, rage, or anger. 

In homeopathic medicine, the fact that certain 
symptoms get better or worse under different conditions 
is used as a diagnostic tool to indicate what remedy will 
be most effective. Symptoms that benefit from treatment 
with apis get worse by applying warmth or drinking 
warm liquids. They also get worse from touch or pres- 
sure, or when the person is in a closed, heated room. The 
symptoms are often worse on the right side, after sleep- 
ing, and in the late afternoon. Symptoms improve with 
the application of cold and exposure to open air. 

Homeopathy also ascribes certain personality types 
to certain remedies. The apis personality is said to be fid- 
gety, restless, and unpredictable. People with the apis per- 
sonality may have wildly inappropriate reactions to emo- 
tional situations. They want company, but reject affection, 
and sometimes insist that they don’t need medical atten- 
tion when they are clearly unwell. People who need apis 
often have bouts of unprovoked jealousy and unprovoked 
tears. They may fear ill health and death greatly. 


There are two homeopathic dilution scales, the deci- 
mal (x) scale with a dilution of 1:10 and the centesimal 
(c) scale with a dilution factor of 1:100. Once the mix- 
ture is diluted, shaken, strained, then rediluted many 
times to reach the desired degree of potency, the final 
mixture is added to lactose (a type of sugar) tablets or 



Edema — Puffiness caused by water retention. 

Propolis — A sticky resin made by honeybees to 
seal the holes in their hives. 

Royal jelly — Special substance secreted by bees to 
feed the young queen bees. 

Tincture — An extract prepared by soaking the 
remedy in alcohol. 

pellets. These are then stored away from light. Homeo- 
pathic apis venom is available commercially in tablets in 
many different strengths. Dosage depends on the symp- 
toms being treated. Homeopathic tincture of whole hon- 
eybee is also available in a variety of strengths. 

Homeopathic and orthodox medical practitioners 
agree that by the time the initial remedy solution is dilut- 
ed to strengths used in homeopathic healing, it is likely 
that very few molecules of the original remedy remain. 
Homeopaths, however, believe that these remedies con- 
tinue to work through an effect called “potentization” 
that has not yet been explained by mainstream scientists. 


No particular precautions have been noted for using 
apis. However, people who are allergic or sensitive to 
bee venom should be cautious. They may react adversely 
to certain potencies of homeopathic apis. 

Side effects 

When taken in the recommended dilute form, no 
side effects from apis have been reported. However, con- 
centrated quantities of the bee venom can cause allergic 
reactions in susceptible people. 


Studies on interactions between apis and conven- 
tional pharmaceuticals are nonexistent. 



Cummings, Stephen, and Dana Ullman. Everybody' s Guide to 
Homeopathic Medicines. 3rd ed. New York: Putnam, 

Hammond, Christopher. The Complete Family Guide to Home- 
opathy. London: Penguin Studio, 1995. 

Lockie, Andrew, and Nicola Geddes. The Complete Guide to 
Homeopathy. London: Dorling Kindersley, 1995. 



Foundation for Homeopathic Education and Research. 21 Kit- 
tredge St., Berkeley, CA 94704. (510) 649-8930. 

International Foundation for Homeopathy. RO. Box 7, Ed- 
monds, WA 98020. (206) 776-4147. 

National Center for Homeopathy. 801 N. Fairfax St., Suite 306, 
Alexandria, VA 22314. (703) 548-7790. 


Homeopathic Internet Resources, <> 
and <www/homeopathy.html> 

Tish Davidson 



Apitherapy involves the therapeutic use of honeybee 
products, including bee pollen, honey, propolis, royal 
jelly, beeswax, and venom, to treat a variety of ailments. 
The most well-known and well-practiced facet of apithera- 
py is Bee Venom Therapy (BVT), which involves the med- 
icinal use of bee stings. The venom is thought to reduce in- 
flammation and boost the body’s immune system. When 
most people refer to apitherapy, they are referring to BVT. 


The medicinal use of bees goes back to ancient times. 
Chinese texts dating back 2,000 years mention it, and Hip- 
pocrates wrote about it. The Egyptians were said to treat 
diseases with an ointment made from bees, and Greek 
physician and writer Galen (129-c. 199), wrote about bee 
treatments. In 1888, Phillip Terc, an Austrian physician, 
published a paper on one of the first clinical studies in- 
volving bee stings titled Report About a Peculiar Connec- 
tion Between the Beestings and Rheumatism. Thereafter, 
its use expanded throughout Europe and the United States. 
It spread as a type of folk remedy popularized by anecdo- 
tal accounts, but as the twenty-first century approached, 
the medical community began investigating the therapy, 
studying its use on a pharmacological level. Though clini- 
cal studies had begun by 2000, most people using the ther- 
apy were either doing it themselves or with the help of lay 
practitioners. Physicians were beginning to use the thera- 
py but mostly with an injectable form of the venom. 


The American Apitherapy Society says it has anec- 
dotal evidence showing bee venom is effective in the 
treatment of: 


• immune system problems, such as arthritis and multi- 
ple sclerosis (MS) 

• cardiovascular disease, such as hypertension, arrhyth- 
mias, atherosclerosis, and varicose veins 

• endocrine disorders, such as premenstrual syndrome, 
menstrual cramps, irregular periods, and decreased 
blood glucose levels 

• infections, like herpes simplex 1 and 2, warts, mastitis, 
and laryngitis 

• psychological disturbances, such as depression or 
mood swings 

• rheumatologic disturbances, such as rheumatoid 
arthritis, osteoarthritis, juvenile rheumatoid arthri- 
tis, bursitis, and “tennis elbow” 

• skin conditions, such as eczema, psoriasis, corns, 
warts, and topical ulcers 

Apitherapy is thought of as a last-resort treatment but 
may be beneficial to those who cannot be helped by tradi- 
tional therapies and medicines. MS patients have reported 
increased stability, along with less fatigue and muscle 
spasm, after trying the therapy. Patients with rheumatoid 
arthritis and osteoarthritis have said pain and swelling have 
decreased following the stings. It has also been said to shrink 
the size of rheumatoid nodules. For those who have not 
achieved relief with other treatments, apitherapy may help. 


Honey bee venom contains more than 40 active sub- 
stances, many of which have physiological effects. The 
most abundant compound is an anti-inflammatory agent 
called melittin. This substance causes the body to pro- 
duce cortisol, which is an agent of the body’s own heal- 
ing process. As an anti-inflammatory, melittin is 100 
times more potent than hydrocortisol. It is noted in Paul 
L. Cerrato’s RN article that experiments have shown that 
melittin can slow the body’s inflammatory response. 
That is why the venom may be helpful in treating inflam- 
matory conditions such as rheumatoid arthritis. 

Other compounds that may have pharmacological ef- 
fects include apamin, which works to enhance nerve trans- 
mission; adolapin, which is an anti-inflammatory and an 
analgesic; and other neurotransmitters like norepinephrine 
and dopamine and seratonin, which figure in depression. 

The most prevalent use of BVT is for immune sys- 
tem and inflammatory disorders. One of the most promis- 
ing uses may be relieving the symptoms of treatment-re- 
sistant MS. More than 1,300 people with MS have sent 
testimonials to the American Apitherapy Society in sup- 
port of the treatment saying the therapy helped relieve fa- 
tigue and muscle spasm, as well as to restore stability. 




Most people receiving the therapy do it themselves 
or with the help of a lay practitioner. The cost of learning 
the therapy and the cost for the bees is generally not cov- 
ered by insurance. The therapy may be covered, howev- 
er, if prescribed and administered by a physician who 
uses an injectable form. 

To receive treatment, a bee is taken from a jar or hive 
with a pair of tweezers and held on the body part to be 
stung. The stinger should be left in for 10 to 15 minutes. 
The number of stings delivered in a session and the fre- 
quency of the sessions varies, depending on the patient’s 
tolerance and the nature of the problem. To treat ten- 
donitis, a patient might need only two to five therapy ses- 
sions involving only two to three stings per session. Treat- 
ing a more chronic problem like arthritis can take several 
stings per session two to three times per week for up to 
three months. Treating MS is a prolonged effort. Those 
who have used it say the therapy must happen two to three 
times per week for six months in order to start working. 

On average, doctors who use the therapy delivered 
injections one to two times per week. The number of in- 
jections varied widely, from one to 30 per session, de- 
pending on the ailment being treated. 

Physicians who use the therapy do not use live bees. 
Instead, they obtain venom in an injectable form and in- 
ject it under the skin. 

Obviously, the more stings or injections to be adminis- 
tered, the more time the therapy is going to take per session. 


Before the therapy is begun, a doctor will inject the 
patient with a weak form of the venom to test for allergic 
reaction. The doctor will have a syringe of epinephrine 
nearby in case a reaction does occur. If the patient is al- 
lergic to the venom, the therapy cannot be administered. 

Lay practitioners and beekeepers who deliver live 
stings test patients with an initial sting to the knee or 
forearm and observe the patient to see if they are aller- 
gic. The test sting should only be administered if the 
practitioner has a bee-sting kit containing epinephrine 
nearby. If a person is allergic, a reaction will generally 
occur in 15 to 20 minutes. Up to 2% of the population 
may be allergic to insect venom. 

Ice may be used to numb the area where the stings 
will occur. It can also be used afterward to soothe the pain. 


Venom therapy should not be used by those with se- 
vere allergies, tuberculosis, syphilis, gonorrhea, and 
transient insulin-dependent diabetes. 



Cardiovascular — Refers to the heart and blood 
vessels as a unified system. 

Multiple sclerosis — A chronic, debilitating disease 
that affects the central nervous system causing a 
loss of muscular coordination, speech defects, 
and the like. 

Propolis — A brownish, waxy substance that bees 
collect from the buds of certain trees and use to 
glue their hives together. 

Tendonitis — Refers to an inflammation of the ten- 
dons, the fibrous connective tissue that attaches 
muscle to bone. 

Side effects 

Pain, itching, and swelling are common at the injec- 
tion or sting site. Patients should also be cautioned that 
severe anaphylactic allergic reactions can lead to respira- 
tory problems, cardiac collapse, and death. Some may 
develop nodular masses or ulcers at sting sites. 

It seems, however, that major complications are rare. In 
September 1999, it was reported in Patient Care magazine 
that Christopher M. H. Kim, director of the Monmouth Pain 
Institute in Red Bank, New Jersey, says he has given more 
than 34,000 injections to 174 patients over the past 15 years 
and has yet to see any major complications. The venom 
Kim injects is equivalent to one to ten bee stings. The most 
common side effect reported by his patients is itching, re- 
ported by 80% of his patients after the first session. After 12 
sessions, however, only 40% still experienced itching. Of 
his patients, 29.7% reported swelling; 6.4% reported 
headache; and 5.6% reported flushing. 

Research & general acceptance 

Due to a growing body of anecdotal evidence to sup- 
port the use of BVT, formal clinical studies were 
launched as 2000 approached. The National Multiple 
Sclerosis Society has begun funding a study on apithera- 
py at Georgetown University Medical Center in Washing- 
ton, D.C. The results were expected by the end of 2000. 

While the study is ongoing, Joseph A. Bellanti, who 
is overseeing the study, has already changed his view of 
the therapy. “In the beginning I thought it was rather 
strange, but after some investigation, I saw that there are 
definite immunologic changes after bee venom therapy, 
and the use of venom began to seem less farfetched,” he 
told Patient Care. 


Over the years, researchers have experimented with 
the therapy on animals and have found that bee venom 
can keep arthritis at bay in rodents. A study was de- 
scribed in RN in which researchers induced a condition 
similar to rheumatoid arthritis in rats and found that 
daily injections of bee venom suppressed the disease. 

Harvard Medical School professor John Mills, who 
works with arthritis patients, told Country Journal that he 
has seen patients achieve short-term relief through the 
sting therapy, though he does not condone its use. He be- 
lieves the same response could be achieved through drug 
therapy without the allergic risk the venom poses to some. 

While animal studies, preliminary results of clinical 
trials, and anecdotal evidence suggest BVT may have 
therapeutic effects, until clinical trials on humans are 
completed, there is no way to know if the treatment 
works. The placebo effect may also be responsible for 
some degree of benefit patients achieve. 

Training & certification 

Some physicians practice BVT, but the majority of 
those seeking treatment rely on lay practitioners, bee keep- 
ers, themselves, or a partner, who is taught to use the bees. 

Those seeking treatment can contact the American 
Apitherapy Society to find a practitioner near them. 



Cerrato, Paul L. “A Therapeutic Bee Sting?” RN 61, 8 (August 
1998): 57-58. 

D'Epiro, Nancy Walsh. “Bee Venom for Multiple Sclerosis.” 
Patient Care 33, 14 (September 15, 1999): 27-31. 
Granstrom. Chris. “Stinging Away the Pain.” Country Journal 
23, 5 (September/October 1996): 22-25. 

Somerfield, Stanley D. “Bee Venom and Arthritis: Magic, 
Myth or Medicine?” New Zealand Medical Journal 99, 
800 (April 1986): 281-283. 


American Apitherapy Society. 5390 Grande Road. Hillsboro, OH 
45133. (937) 364-1108. <> 


“Bee Venom Therapy.” Spectrum Medical Arts. <http://www2. > 

Lisa Frick 



Appendicitis is an inflammation of the appendix, 
which is the worm-shaped pouch attached to the cecum, 


the beginning of the large intestine. The appendix has no 
known function in the body, but it can become diseased. 
Appendicitis is a medical emergency, and if it is left un- 
treated, the appendix may rupture and cause a potentially 
fatal infection. 


Appendicitis is the one of the most common abdomi- 
nal emergencies found in the United States. More males 
than females develop appendicitis. It is rare in the elderly 
and in children under the age of two. The hallmark symp- 
tom of appendicitis is increasingly severe abdominal 
pain. Since many different conditions can cause abdomi- 
nal pain, an accurate diagnosis of appendicitis can be dif- 
ficult. Other conditions can have symptoms similar to ap- 
pendicitis, especially in women. These include pelvic in- 
flammatory disease, ruptured ovarian follicles, ruptured 
ovarian cysts, tubal pregnancies, and endometriosis. 
Various forms of stomach upset and bowel inflammation 
may also mimic appendicitis. 

A timely diagnosis of appendicitis is important, be- 
cause a delay can result in perforation, or rupture, of the 
appendix. When this happens, the infected contents of 
the appendix spill into the abdomen, potentially causing 
a serious infection of the abdomen called peritonitis. 
Very rarely, the inflammation and symptoms of appen- 
dicitis may disappear but recur again later. If appendici- 
tis is suspected, the following activities should be avoid, 
as they may cause the appendix to rupture: 

• consuming food or drink 

• taking pain medication, laxatives, or antacids 

• the use of a heating pad on the affected area 

Causes & symptoms 

The causes of appendicitis are not totally under- 
stood, but are believed to occur as a result of blockage of 
the appendix. This blockage may be due to fecal matter, 
a foreign body in the large intestine, cancerous tumors, a 
parasite infestation, or swelling from an infection. 

The distinguishing symptom of appendicitis is the 
migration of pain to the lower right corner of the ab- 
domen. The abdomen often becomes rigid and tender to 
the touch. The patient may bend the knees in reaction to 
the pain. Increased rigidity and tenderness indicate an in- 
creased likelihood of perforation and peritonitis. Loss of 
appetite is very common, accompanied by a low-grade 
fever, and occasionally there is constipation or diar- 
rhea, as well as nausea. Unfortunately, these signs and 
symptoms may vary widely. Atypical symptoms are par- 
ticularly present in pregnant women, the elderly, and 
young children. 




An extracted appendix. (Photograph by Lester V. Bergman, 
Corbis Images. Reproduced by permission.) 

If bacteria multiply unchecked within the appendix, it 
will become swollen and filled with pus, and may eventual- 
ly rupture. This produces an inflammation of the lining of 
the abdominal wall, or peritonitis, which is a medical emer- 
gency. Signs of rupture include the presence of symptoms 
for more than 24 hours, a high fever, a distended abdomen, 
a high white blood cell count, and an increased heart rate. 


A careful examination is the best way to diagnose 
appendicitis. It is often difficult even for experienced 
physicians to distinguish the symptoms of appendicitis 
from those of other abdominal disorders. The physician 
will ask questions regarding the nature and history of the 
pain, as well doing an abdominal exam to feel for in- 
flammation, tenderness, and rigidity. Bowel sounds will 
be decreased or absent. A blood test will be given, be- 
cause an increased white cell count may help confirm a 
diagnosis of appendicitis. Urinalysis may help to rule out 
a urinary tract infection that can mimic appendicitis. In 
cases with a questionable diagnosis, other tests, such as a 
computed tomography scan (CT) or ultrasound may be 
performed to help with diagnosis without resorting to 
surgery. Abdominal x rays, however, are not of much 
value except when the appendix has ruptured. 


Patients whose symptoms and physical examination 
are compatible with a diagnosis of appendicitis are usu- 
ally hospitalized and a surgical exploration of the ab- 
domen, called a laparotomy, is done immediately to con- 
firm the diagnosis. A normal appendix is discovered in 
about 10-20% of patients who undergo laparotomy. Be- 
cause of the potential for a life-threatening ruptured ap- 
pendix, persons suspected of having appendicitis are 
often taken to surgery before the diagnosis is certain. If 
the symptoms are not clear, surgery may be postponed 
until they progress enough to confirm a diagnosis. Some- 
times the surgeon will remove a normal appendix as a 
safeguard against appendicitis in the future. 


Appendicitis must be treated by a surgeon in a hos- 
pital setting. However, acupressure can be helpful for 
recuperation. One dose of homeopathic phosphorus 30c 
can be taken before surgery to help reduce nausea, light- 
headedness, and disorientation due to anesthesia. Phos- 
phorus 6c can be also taken two to three times in the 
hours following surgery. Other appropriate remedies 
may include Aconite napellus 30c, Arnica montana 30c, 
Gelsemium 6c, and Staphysagria 30c. 

Allopathic treatment 

The treatment for sudden, severe appendicitis is 
surgery to remove the appendix, called an appendecto- 
my. An appendectomy may be done by opening the ab- 
domen in the standard operating technique, or through 
laparoscopy, in which a small incision is made through 
the navel. Recovery may be faster with a laparoscopy 
than with an ordinary appendectomy. An appendectomy 
should be performed within 48 hours of the first appear- 
ance of symptoms, to avoid a rupture of the appendix 
and peritonitis. Antibiotics are given before surgery in 
case peritonitis has already taken hold. If peritonitis is 
discovered, the abdomen must also be irrigated and 
drained of pus, and then treated with multiple antibiotics 
for 7-14 days. 

Expected results 

Appendicitis is usually treated successfully by ap- 
pendectomy. Unless there are complications, the patient 
should recover without further problems. The mortality 
rate in cases without complications is less than 0.1%. 
When an appendix has ruptured, or a severe infection has 
developed, the likelihood is higher for complications, 
with slower recovery, or death from disease. There are 
higher rates of perforation and mortality among children 
and the elderly. 



Laparotomy — Surgical incision into the loin, be- 
tween the ribs and the pelvis, which offers sur- 
geons a view inside the abdominal cavity. 

Pus — A fluid formed in infected tissue, consisting 
of while blood cells and cellular debris. 


Appendicitis is probably not preventable, although 
there is some indication that a diet high in leafy green 
vegetables may help prevent appendicitis. 



The Editors of Time-Life Books. The Medical Advisor-: The 
Complete Guide to Alternative and Conventional Treat- 
ments. Virginia: Time-Life, Inc., 1996. 

Lininger, D.C., Skye, editor-in-chief, et al. The Natural Phar- 
macy. California: Prirna Health, 1998. 

Yamada, Tadataka, ed. et al. Textbook of Gastroenterology. 
Philadelphia: J.B. Lippincott, 1995. 


Van Der Meer, Antonia. “Do You Know the Warning Signs of 
Appendicitis?” Parents Magazine (April 1997). 

Wagner J.M., et al. "Does This Patient Have Appendicitis?” 
JAMA: The Journal of the American Medical Association 
276 (1996). 

Patience Paradox 

Applied kinesiology 


Applied kinesiology (AK) is the study of muscles 
and the relationship of muscle strength to health. It in- 
corporates a system of manual muscle testing and thera- 
py. AK is based on the theory that an organ dysfunction 
is accompanied by a specific muscle weakness. Diseases 
are diagnosed through muscle-testing procedures and 
then treated. AK is not the same as kinesiology, or bio- 
mechanics, which is the scientific study of movement. 


AK is based on principles of functional neurology, 
anatomy, physiology, biomechanics, and biochemistry as 


well as principles from Chinese medicine, acupuncture, 
and massage. It was developed from traditional kinesiol- 
ogy in 1964 by George G. Goodheart, a chiropractor 
from Detroit, Michigan. He observed that each large 
muscle relates to a body organ. A weakness in a muscle 
may mean that there is a problem in the associated 
organ. Goodheart found that by treating the muscle and 
making it strong again, he was able to improve the func- 
tion of the organ as well. For example, if a particular nu- 
tritional supplement was given to a patient, and the mus- 
cle tested strong, it was the correct supplement for the 
patient. If the muscle remained weak, it was not. Other 
methods of treatment can be evaluated in a similar man- 
ner. Goodheart also found that painful nodules (small 
bumps) may be associated with a weak muscle. By 
deeply massaging the muscle, he was able to improve its 
strength. Goodheart ’s findings in 1964 led to the origin 
and insertion treatment, the first method developed in 
AK. Other diagnostic and therapeutic procedures were 
developed for various reflexes described by other chiro- 
practors and doctors. Goodheart incorporated acupunc- 
ture meridian therapy into AK after reading the writings 
of Felix Mann, M.D. 

Goodheart considered AK to be a therapeutic tool 
that incorporates feedback from the body. He said that 
“applied kinesiology is based on the fact that the body 
language never lies.” He felt that the body’s muscles 
were indicators of disharmony. Once muscle weakness 
has been ascertained, the problem may be solved in a va- 
riety of ways. If a practitioner approaches the problem 
correctly, he believed, making the proper and adequate 
diagnosis and treatment, the outcome is satisfactory both 
to the doctor and to the patient. 


AK is not designed for crisis medicine. For example, 
an AK practitioner cannot cure cancer, arthritis, diabetes, 
heart disease, or infections. This therapy is designed to 
be a part of a holistic approach to preventive medicine. 
The goals of AK are to (1) restore normal nerve function, 
(2) achieve normal endocrine, immune, digestive, and 
other internal organ functions, (3) intervene early in de- 
generative processes to prevent or delay pathological con- 
ditions, and to (4) restore postural balance, correct gait 
(walking) impairment, and improve range of motion. 


According to AK, each muscle in the body relates to 
a specific meridian or energy pathway (acupuncture 
lines) in the body. These meridians also relate to organs 
or glands, allowing the muscles to provide information 
about organ or gland function and energy. The five areas 


Applied kinesiology 

Applied kinesiology 


Dr. George Goodheart was born in Detroit, Michi- 
gan, in 1918 and became a second-generation doctor 
of chiropractic. He graduated from the National College 
of Chiropractic in 1939 and is recognized as the 
founder and developer of applied kinesiology. After he 
joined the U.S. Air Force as an aviation cadet in World 
War II, he received a promotion to major at the age of 
22. He was the youngest ever to attain that rank. He 
served in active duty from 1941-1946 and continued as 
a member of the Air Force Reserve until the mid-1 950s. 

Goodheart held numerous positions of distinction 
during his career, including director of the National 
Chiropractic Mutual Insurance Company and director 
for the International College of Applied Kinesiology- 
U.S.A. He also lectured and taught throughout the Unit- 
ed States, Japan, Europe, and Australia; and he was the 
official doctor of chiropractic for the Lake Placed Win- 
ter Olympic Games in 1980. He contributes to a variety 
of trade publications on a regular basis. 

In 1998 Goodheart received a Lifetime Achieve- 
ment Award from the International College of Kinesiolo- 
gy. Earlier, in 1987 he was honored with the Leonardo 
da Vinci Award from the Institute for the Achievement of 
Human Potential, and he was cited for his research by 
Logan and Palmer Colleges of Chiropractic. He repre- 
sented the State of Michigan as a delegate to the Ameri- 
can Chiropractic Association and was a fellow at the In- 
ternational College of Chiropractic. He resides with his 
wife, JoAnn in Grosse Pointe Woods, Michigan, where 
he enjoys skiing and tennis. 

Gloria Cooksey 

of diagnosis and therapy for the applied kinesiologist are 
(1) the nervous system, (2) the lymphatic system, (3) the 
vascular (blood vessel) system, (4) the cerebrospinal sys- 
tem, and (5) the meridian system. 

The first part of AK is muscle testing, which is used 
to help diagnose what part of the body is functioning ab- 
normally. Muscle testing involves putting the body into a 
position that requires a certain muscle to remain contract- 
ed, and then applying pressure against the muscle. The 
testing does not measure strength but is meant to reveal 
stresses and imbalances in the body through the tension 
in the muscle. The test evaluates the ability of a control- 
ling system (like the nervous system) to adapt the muscle 
to meet the changing pressure of the examiner’s test. AK 
practitioners also examine structural factors such as pos- 
ture, gait, and range of motion. Some chiropractors use 
AK to help them evaluate the success of spinal adjust- 


ment. A leg muscle is tested for strength or weakness to 
determine whether the adjustments made are appropriate. 

According to AK, common internal causes of mus- 
cle weakness include; 

• dysfunction of nerve supply (nerve interference be- 
tween spine and muscles) 

• impairment of lymphatic drainage 

• reduction of blood supply 

• abnormal pressure in cerebral fluid affecting nerve-to- 
muscle relationships 

• blockage of an acupuncture meridian 

• imbalance of chemicals 

• dysfunction of organs or glands 

• excesses or deficiencies in nutrition 

Physiological reactions to chemicals, including 
those associated with nutrition and allergies, may also 
be evaluated using AK. The AK protocol for testing 
chemical compounds is to place the substance on the pa- 
tient’s tongue so that he tastes the material, and the nor- 
mal chemical reactions of ingestion begin. In some 
cases, the substances are inhaled through the nose. The 
AK practitioner then tests the associated muscle-organ 
pattern to determine where or if there is a strength or 
weakness. The patient does not need to swallow the sub- 
stance for a change in strength or weakness to be identi- 
fied. David S. Walther, a diplomate of the International 
College of Applied Kinesiology, has indicated that “it is 
possible that the central nervous system, recognizing the 
compound being ingested, relays information to the or- 
gans and glands preparing for use of the compound. If 
the compound is recognized as beneficial, the energy 
pattern is immediately enhanced, influencing not only 
the organ or gland, but also the associated muscle.” 

AK has been used as a diagnostic health tool for a 
variety of conditions. 

Bone health 

• neck/low back pain and sciatica 

• whiplash 

• frozen shoulder 

Joint health 

• carpal tunnel syndrome 

• arthritis (including rheumatoid arthritis) 

• sports injuries 

Muscle health 

• tennis elbow 

• heel spurs 


wound healing 

intermittent claudication (pain on walking) 

restless legs 


Vascular system health 
aching varicose veins 
high blood pressure 
Nervous system health 
migraine and other headaches 
trigeminal neuralgia and other face pains 
Bell’s palsy 

addictions (like smoking) 


Meniere’s disorder 

neuralgia (severe, throbbing pain) 

travel sickness 


phantom limb pain 
paralysis of leg or arm after a stroke 
Respiratory system health 
hay fever 

rhinitis (inflammed nasal passages) 



emphysema (lung disease) 

Urinary system health 

cystitis (bladder inflammation), especially in the elderly 
early prostate enlargement 

non-specific urethritis (inflammation of tube from the 


Reproductive organ health 
menstrual pains 

irregular or excessive menstrual activity 
pelvic pains and endometriosis 
menopausal flushes 
painful, nodular breasts 

• preparation for childbirth 

• vaginal pain 

• post herpetic (shingles) pain 

• impotence and infertility 

Skin health 

• pain after operations 

• painful, prominent scars 

• wrinkles or bagginess of face 

• acne 

• psoriasis and eczema (skin diseases) 

• boils 

• excessive perspiration 

• hemorrhoids 

• canker sores 

• itching 

Immune system health 

• recurring tonsillitis (inflammed tonsils) 

• persisting weakness after a severe illness 

Sensory organ health 

• tinnitus (ringing ears) 

• tired eyes 

• retinitis pigmentosa and pterygium retinitis (diseases of 
the retina) 

Digestive system health 

• constipation 

• colitis or other bowel inflammations 

• ulcers 

• diarrhea 

• obesity 

The second part of AK involves the treatment phase. 
Goodheart and other practitioners of AK have adapted 
many treatment methods for the problems that are diag- 
nosed with muscle testing. Examples of treatment meth- 
ods include special diets, dietary supplements, chiro- 
practic manipulation, osteopathic cranial techniques, 
acupuncture/meridian therapies, acupressure, deep mus- 
cle massage, and nervous system coordination proce- 
dures. For example, an AK practitioner might treat asth- 
ma by looking for weaknesses in specific lower back and 
leg muscles that share a connection with the adrenal 
glands. The practitioner will strengthen these muscles 
and help the adrenal gland produce bronchodilators, 
chemicals that relax or open air passages in the lungs. 



Applied kinesiology 

Applied kinesiology 

The practice of kinesiology requires that it be used 
in conjunction with other standard diagnostic methods 
by professionals trained in clinical diagnosis. Most prac- 
titioners of AK are chiropractors, but naturopaths, med- 
ical doctors, dentists, osteopaths, nutritionists, physical 
therapists, massage therapists, podiatrists, psychiatrists, 
and nurse practitioners are also involved. In 1991, 37.2% 
of 4,835 full-time chiropractors in the United States who 
responded to a survey by the National Board of Chiro- 
practic Examiners (NBCE) said they used AK in their 
practice. Subsequent NBCE surveys indicated that 31% 
of chiropractors in Canada, 60% in Australia, and 72% in 
New Zealand use AK. 

Most practitioners of AK utilize a holistic approach 
and evaluate a person from a triad-based health perspec- 
tive. Generally, chiropractors approach health and heal- 
ing from a structural basis, medical doctors generally 
from a chemical basis, and psychiatrists and psycholo- 
gists from a mental or emotional basis. Applied kinesiol- 
ogists attempt to work with all three areas of health, and 
in some cases, include a spiritual dimension. 

The use of AK is often included in insurance cover- 
age if the policy covers chiropractor benefits. The cost of 
the AK examination is similar to the costs of other chiro- 
practic practices. 


Since AK is a non-invasive diagnostic tool, there are 
no preparations required. 


AK should only by used by trained professionals 
with the necessary expertise to perform specific and ac- 
curate tests. The AK examination should be combined 
with a standard physical diagnosis, which often includes 
laboratory tests, x rays, health and dietary history, and 
other special tests. An AK examination should enhance a 
standard diagnosis, not replace it. The total diagnostic 
work-up should be used to determine the final diagnosis. 

The use of manual muscle testing to evaluate nutri- 
tion is particularly a problem if it is done by a lay nutri- 
tion sales person as a tool to sell his/her product. The per- 
son should have the educational background to evaluate 
nutritional needs as well as have a high level of knowl- 
edge in the use of proper muscle testing techniques. 

Side effects 

If AK is performed by a trained practitioner with the 
appropriate educational background, side effects from 
the muscle-testing procedures should be minimal. 


Research & general acceptance 

AK is a tool that is used by many health care profes- 
sionals, and especially by chiropractors. A literature re- 
view published in 1999 by researchers from the School 
of Medicine at the University of North Carolina at 
Chapel Hill and the Foundation for Allied Conservative 
Therapies Research in Chapel Hill stated that, although 
AK appears to be a promising methodology, there is a 
lack of research results relevant to clinical practice and 
outcomes of AK care. They found this lack of results 
surprising, since cost, satisfaction, utilization, and 
changes in symptoms are the important results of clinical 
practice. In addition, they determined that some studies 
that were supposed to be an evaluation of AK procedures 
did not actually use clinical practices and principles of 
AK. However, from studies adhering to AK principles 
and employing standardized training by well-trained 
practitioners, they did state there was some evidence that 
AK is an objectively verifiable phenomenon. They sug- 
gested that “future studies of AK should focus on out- 
comes of care, including symptoms, function, costs, and 
safety. Only well-designed studies that account for the 
individual nature of AK diagnosis and treatment and pre- 
serve the proper clinical context of AK treatment will be 
informative. Understanding the individual components 
of the process of AK treatment remains important. Stud- 
ies addressing validation of isolated AK procedures need 
to meet the methodological challenges of studying ap- 
propriate subjects that reflects the current recognized 
practice and understanding of AK. Further evaluation of 
the basic physiologic phenomena involved and correla- 
tion of AK manual muscle test results will also advance 
understanding of this diagnostic and therapeutic system.” 

Training & certification 

In 1976, a group of doctors who were practicing AK 
founded the International College of Applied Kinesiology 
(ICAK). The purpose of the ICAK is to promote teaching 
and research of AK. The college does not have physical 
buildings. Instead, it is an organization to bring together 
those in the health field with common interests and goals 
and to provide education in the use of AK. The organiza- 
tion has chapters representing Belgium, Luxembourg, 
and the Netherlands (BeNeLux), Germany, France, Italy, 
Germany, Scandanavia, United Kingdom, Canada, Aus- 
tralia and Asia (Australasia), and the United States. 

AK is performed by a healthcare professional who 
has basic education in his or her field of practice. To be- 
come an applied kinesiologist, the healthcare profession- 
al must study the principles in a basic course, which in- 
cludes 100 hours of classroom study taught by a diplo- 
mate of the ICAK. At the end of this course, students 


take a basic proficiency test. To obtain certification by 
the board of ICAK, the professional must complete 300 
hours of continuing classes, pass a diplomate test (a 
comprehensive written and practical test), and present 
two research papers to the general membership of ICAK. 



Holdway, Anne. Kinesiology: Muscle Testing and Energy Bal- 
ancing for Health and Well-Being. Rockport, MA: Ele- 
ment, 1997. 

Valentine, Tom, Carol Valentine, and D.P. Hetrick. Applied Ki- 
nesiology. Rochester, VT: Healing Arts Press, 1989. 


International College of Applied Kinesiology. 6405 Metcalf Ave„ 
Suite 503, Shawnee Mission, KS 66202. 913-384-5336. 
< and> 

Judith Sims 

Apricot seed 


Apricot seed is the small kernel enclosed within the 
wood-like pit at the center of the apricot fruit. The apri- 
cot tree carries the botanical name Primus armeniaca. It 
is a drupe, meaning stone-fruit, and a close relative of 
the peach. Both are very similar in appearance and quali- 
ties. The apricot is also sometimes called apricock or Ar- 
meniaca vulgaris. Like the plum, both peaches and apri- 
cots are distantly related to the rose and are classified as 
members of the Rosacaeae family. 

Apricots grow on small to medium size trees, which 
are hardy in most temperate areas. White, multi-petaled 
blossoms with a slight reddish tinge nearer to the base of 
the flower emerge onto the bare branches in early spring, 
before the tree's heart-shaped leaves appear. By late July 
or early August, the apricot fruit ripens. There are more 
than 20 varieties of apricot known to botanists. 

The name Primus armeniaca is actually a misnomer 
based upon the long-held belief that apricots initially came 
from Armenia. It is now known that in reality they originat- 
ed in the Far East, most likely in the Himalayas and North- 
ern China. It is speculated that the apricot had already mi- 
grated to the Middle East before the Old Testament and that 
the apples described in the Garden of Eden in Genesis were 
actually apricots. During the reign of King Henry VIII in 
the 1500s, apricots were brought to England from Italy. 


Though smaller than the peach, apricots have the 
same russet-tinted, golden, velvet appearing exterior and 
deeper golden-orange flesh inside. The innermost layers 
form the large, woody compressed stone, or pit, that con- 
tains at its very center, the kernel, or seed. When pressed, 
nearly half of this kernel gives forth an oil very chemi- 
cally similar to the oil found in sweet almond and peach 
kernels. This oil contains olein, glyceride of linoleic 
acid, and a transparent, crystalline chemical compound, 
amygdalin, or laetrile. This compound is also known as 
vitamin B 17 . The oil is chemically indistinguishable from 
oil of bitter almond. Although the oil from apricot seeds 
usually breaks down into a toxic substance capable of 
causing death within the human body, there are also vari- 
eties of apricot seed that are reported to be edible. 

General use 

Because the oil from the apricot seed is far less ex- 
pensive than oil of almond, confectioners use it in place of 
bitter almond oil for flavoring sweets and as a culinary 
seasoning. A liqueur manufactured in France is made 
from apricot seed and is called Eau de Noyaux. Apricot oil 
is also used extensively in the manufacture of cosmetics, 
often being fraudulently added to almond oil. It has skin 
softening properties and is often used in making soaps, 
hand creams, cold cream, and perfume preparations. 

Chinese Medicine practitioners use apricot seed as a 
treatment in respiratory diseases, including bronchitis 
and emphysema. It is believed to act as an cough sup- 
pressant and expectorant and, because of the oil, also 
used as a laxative. 

There has been considerable controversy regarding 
apricot seed, and specifically amygdalin, one of its com- 
ponents. Since the 1920, in many countries around the 
globe it has been recognized as a possible cancer preven- 
tative and malignant cell growth inhibitor. In San Francis- 
co, biochemist Ernst Krebs’s article The Nitrilosides ( Vit- 
amin B 17 )-Their Nature , Occurrence and Metabolic Sig- 
nificance (Antineoplastic Vitamin B I7 ) theorized that 
amygdalin, with diet and vitamins, could inhibit cancer- 
ous growths. In the years since, it has been used in many 
countries as a cancer treatment, thought to be especially 
beneficial in the treatment of smoking-related tumors 
such as lung cancer. Several studies done in the United 
States throughout the 1970s and early 1980s demonstrat- 
ed that amygdalin did not kill cancer cells. Review of pa- 
tients’ records where there had been reported cures or re- 
markable size reduction in tumors did not provide credi- 
ble evidence of amygdalin ability to treat cancer effec- 
tively. There has been significant documentation that 
amygdalin breaks down into cyanide, a potent poison, in 


Apricot seed 



Expectorant — An agent that facilitates the removal 
of the secretions of the bronchopulmonary mu- 
cous membrane. 

Unapproved drug — The FDA is responsible for en- 
suring that biological products are safe and effec- 
tive and in compliance with the law and FDA reg- 
ulations. Biological products are licensed under 
the provisions of Section 351 of the Public Health 
Service Act (42USCKPHS Act). 

the human body, and when taken in sufficiently high 
doses, can actually bring on death due to its toxicity. 


Apricot seed is not sold in American health food 
stores due to its classification as an unapproved drug by 
the U.S. Food and Drug Administration. However, it is 
available in other countries, including Mexico, and in 
Chinese pharmacies and Asian markets. It is sold both as 
the whole kernel or seed, or in decoctions including 
cough syrups. Chinese practitioners usually combine 
apricot seed with other herbs, including white mulberry 
leaf or ophiopogon, a tuber grown in Asia. A paste made 
of apricot seed and sugar has been shown, in some Chi- 
nese medical trials, to relieve chronic bronchitis. 


As noted previously, the amygdalin in apricot seed 
breaks down within the body into a form of the deadly 
poison cyanide, or prussic acid. There has been consider- 
able debate concerning its level of toxicity to human be- 
ings. Following an Oklahoma judicial decision legalizing 
the importation of amygdalin in 1986, clinical trials were 
begun by the FDA and National Cancer Institute in 1987. 
Amygdalin was used, along with the diet, enzymes, and 
vitamins suggested by pro-amygdalin factions. The re- 
port from this study concludes: “No substantive benefit 
was observed in terms of cure, improvement, or stabi- 
lization of the cancer.’’ They further reported that “the 
hazards of amygdalin therapy were evidenced in several 
patients by symptoms of cyanide toxicity or by blood 
cyanide levels approaching lethal range. Amygdalin is a 
toxic drug that is not effective as a cancer treatment.” It 
has been reported that ten apricot seeds can kill a child. 

Side effects 

Chinese practitioners caution using apricot seed if the 
person being treated suffers from diarrhea. Headache 


and nausea have been reported following ingestion of 
small amounts. The most serious side effect of apricot 
seed is potential cyanide poisoning. When large doses of 
cyanide are ingested, death is almost instantaneous. Toxic- 
ity from smaller doses is manifested by vomiting, diar- 
rhea, mental confusion, vertigo, headache, extreme dysp- 
nea, and violent respirations, slow pulse, weakness, glassy 
or protruding eyes, dilated pupils, and a characteristic 
(peach blossoms, bitter almond) odor to the breath. 


Practitioners of Chinese medicine advise that apri- 
cot seed should not be given in combination with the 
herbs astragalus, skullcap, or kudzu root. 



Carper, Jean. The Food Pharmacy. Bantam Books, 1988. 
Grieve, M. and C. F. Leyel. A Modern Herbal: The Medical, 
Culinary, Cosmetic and Economic Properties, Cultivation 
and Folklore of Herbs, Grasses, Fungi, Shrubs and Trees 
With All of Their Modern Scientific Uses. Barnes & Noble 
Publishing, 1992. 

Holvey, David N., MD. Merck Manual. Sharp & Dohme Re- 
search Laboratories, 1972. 

Taber, Clarence Wilbur. Taber's Cyclopedic Medical Dictio- 
nary. F.A. Davis Co. 


Krebs, Ernst T., Jr. “The Nitrilosides (Vitamin B-17)-Their Na- 
ture, Occurence and Metabolic Significance Antineoplas- 
tic Vitamin B- 17).” Journal of Applied Nutrition 1970. 


U.S. Food and Drug Administration. HFI-40, Rockville, MD 
2085.1-888-463-6332. http://www. 

Joan Schonbeck 

Arbor vitae see Thuja 



Arginine is one of the amino acids produced in the 
human body by the digestion, or hydrolysis of proteins. 
Arginine can also be produced synthetically. Because it 
is produced in the body, it is referred to as “nonessen- 
tial,” meaning that no food or supplements are necessary 
for humans to ingest. Arginine compounds can be used 
in treating people with liver dysfunction due to its role in 
promoting liver regeneration. 


General use 

In March 2000 in Newsweek magazine, Stephen 
Williams noted the newly discovered role arginine might 
play in treating people with chronic heart failure (CHF). 
The study, as reported in the Journal of the American Col- 
lege of Cardiology involved 40 patients who suffered from 
CHF. Rainer Hambrecht and colleagues from the Univer- 
sity of Leipzig in Germany did the research by dividing 
the group into four sections. One group took 8 g of argi- 
nine daily for four weeks. A second took no supplement, 
but did daily forearm exercises. The third did both the ex- 
ercises, and took the supplement daily. The fourth group 
was a control group and did nothing except taking their 
usual medication, as did the others. Because of the known 
fact that arginine is naturally converted into nitric oxide by 
the human body, the result of that chemical relaxing blood 
vessels was also known when the experiment began. The 
group that took the arginine alone showed an improve- 
ment in their blood-vessel dilation by four times, as did 
the group doing exercises alone. The third who did both, 
showed an increase six times better than the original 
blood-dilation factor. Promise in the future use of arginine 
in treating heart patients with this condition was indicated 
as researchers continued to perform further tests. Accord- 
ing to an article by Liz Brown written in Better Nutrition 
in June 2000, also discussing the Leipzig study, “Numer- 
ous other studies have shown that arginine has a vadodila- 
tory effect on people with high cholesterol levels, those 
with high blood pressure and others with compromised 
circulation associated with heart disease.” 

Other research in the use of arginine has indicated 
that arginine is crucial to the wound-healing process, 
particularly in the elderly for whom blood circulation is 
poor. Arginine is necessary for growth periods but not 
for body maintenance. 

Benefits of the use of arginine as a supplement include: 

• improves immune response to bacteria, viruses, and 
tumor cells. 

• promotes wound healing by repairing tissues 

• plays a crucial role in the regeneration of liver 

• responsible for release of growth hormones 

• promotes muscle growth 

• improves cardiovascular functioning 

Arginine is used as a supplement in the treatment of 
heart patients with arterial heart disease; as an intra- 
venous supplement to patients with liver dysfunction; as 
a supplement for easing exercise-related pains due to the 
heart muscle not getting enough blood to circulate to the 
muscles in the calves. Supplements that combine argi- 
nine with other amino acids, such as ornithine and 


lysine, are purported to assist in muscle-building exercis- 
es by minimizing body fat and maximizing muscle tone. 
Results vary among those who have taken these supple- 
ments. Arginine is also present in “multi” amino acids 
capsules that are taken as a dietary supplement. 

New information released in 2002 showed that treat- 
ment with arginine improved immune function in HIV 
patients and proved safe for these patients when used on 
a short-term patients. Other new research was finding 
that arginine supplements worked as an effective antico- 
agulant, but unlike aspirin and other anticoagulants, 
could prevent clotting without increasing stroke risk. 
New research also is showing arginine’s effectivenss in 
fighting cancer and protecting and detoxifying the liver, 
improving male fertility, and promoting healing. 


Arginine supplements as an alternative medicine 
therapy are normally taken in either tablet or capsule 
form. In naturopathic treatment of liver dysfunction, the 
supplement would be added intravenously as a powder 
diluted in liquid. Discoveries reported in 2000 indicated 
that in the treatment of arterial heart disease, the inges- 
tion of arginine tablets or capsules of 6-9 g a day are 
helpful in dilating blood vessels to ease circulation and 
prevent the buildup of cholesterol. 


Long-term effects of arginine supplements have not 
yet been determined. Consultation with a physician re- 
garding individual needs is always advised. Individuals 
who attempt to treat their own heart ailments, or intend 
to guard against any potential difficulty, should seek ad- 
vice of a physician. Arginine does not show any positive 
results in treatment of men with damaged valves or en- 
larged heart tissue. 

Arginine has been suspected in the formation of cold 
sores. Some practitioners suggest that consuming foods 
high in arginine, such as nuts, grains, and chocolates, can 
promote cold sores. Reducing intake of foods high in 
arginine and increasing intake of lysine (another amino 
acid) can reduce or even eliminate the cold sore problem. 

Side effects 

As previously noted, the use of supplemental argi- 
nine should be monitored for use with specific problems. 
Overdose could result in unforeseen complications, 
while regular use might or might not help ease everyday 
problems, such as relaxation of muscles not due to the 
specific heart ailment of arterial disease. People who 
should not take arginine supplements are those predis- 




posed to herpes outbreaks; cancer patients, due to possi- 
ble increase in cell replication of cancerous cells; those 
with low blood pressure; and individuals with certain 
liver or kidney problems. Those taking blood thinners 
are advised to seek medical advice before taking the sup- 
plement. Pregnant women are also cautioned against tak- 
ing the supplements due to the unknown affect it could 
have on both mother and child. 


Long-term studies are ongoing. While no adverse re- 
actions of ordinary supplements of 6-9 g a day have yet 
been documented, caution is urged. Because amino acids 
are not drugs, their use is not regulated by the U.S. Food 
and Drug Administration (FDA). One study in April 1999 
in Healthlnform: Essential Information on Alternative 
Health Care reported that nutritional supplements of argi- 
nine with omega-3 fatty acids for outpatients with HIV 
showed no particular benefits in immunity. 



“Arginine Treatment man Improve Immune Function.” AIDS 
Weekly (September 23, 2002):3. 

Brown, Edwin W. “Troubled by Cold Sores?” Medical Update 
(March 1999). 

Brown, Liz. “Arginine and Exercise." Better Nutrition ( June 
2000 ). 

Chowienczyk, Phil and Jim Ritter. “Arginine: NO more than a 
simple amino acid?” The Lancet 27 (September 1997). 
Gerard, James M. and Atchawee Luisiri. “A fatal overdose of 
arginine hydrochloride.” Journal of Toxicology (Novem- 
ber 1997). 

Henderson, Charles W. “Suppression of Arginine Transport and 
Nitric Oxide Synthesis in Activated Macrophages by Cat2 
Antisense Oligonucleotides.” Cancer Weekly Plus (28 De- 
cember 1998). 

Klotter, Jule. “Arginine and Heart Disease.” Townsend Letter 
for Doctors and Patients (August-September 2002): 22. 
Marandino, Cristin. “Taking Heart.” Vegetarian Times (Novem- 
ber 1999). 

Pessarosa, A.; Dazzi. D.; Negro, C.; Cebigni, C.; Vescovi, P. P. 
“Effects of Alcohol Consumption and Accompanying Diet 
on Metabolic Response to Arginine in Chronic Alco- 
holics.” Journal of Studies on Alcohol (September 1999). 
“Prospective Study tests Nutritional Supplements enriched 
with Arginine and Omega-3 Fatty Acids.” Healthlnform: 
Essential Information on Alternative Health Care (April 

Rodale Press. “Bypass This Snack." Men's Health (November 

Rodale Press. "Is Being Henpecked Hereditary?" Mens Health 
(January 2000). 

Thomas, Clayton, L., M.D., M.P.H., ed. “Hyperkalemia.” Taber’s 
Cyclopedic Medico Dictionary. Edition 13 Philadelphia: F. 
A. Davis Company, 1977. 



Hyperkalimia — Excessive amount of potassium in 
the blood that serves as an indicator of the possi- 
ble serious complications in bodily functions. 

Webb, Denise. “Ease Exercise-Related Pains with Arginine.” 
Prevention December 1999. 

Williams, Stephen. “Passing the Acid Test.” Newsweek 27 
March 2000. 


“Arginine.” Mosby’s Medical. Nursing & Allied Health Dictio- 
nary, Edition 5 1998. Available from <http://web2.infotrac.> 

Jane Spehar 
Teresa G. Odle 



Arnica ( Arnica montana L.), known also as leopards- 
bane, wolfsbane, and European arnica, is a member of the 
Compositae (Asteraceae) family. This attractive herb is 
native to the mountains of Siberia and central Europe, 
where the leaves were smoked as a substitute for tobacco. 
This practice led to a common name for the herb: moun- 
tain tobacco. There are several North American species of 
arnica, including A. fulgens, A. sororia, and A. cordifolia. 
Arnica thrives in the northern mountains of the United 
States and Canada, in high pastures and woodlands. 

Arnica grows from a cylindrical, hairy rhizome with a 
creeping underground stem. First year leaves are downy 
and grow in a flat rosette at the base of the stem. In the sec- 
ond year, arnica sends up a round, hairy stem with smaller, 
sessile leaves growing in one to three opposite pairs. This 
central stem may branch into three or more stems each 
with a terminal composite blossom. Arnica’s aromatic, 
daisy-like flowers have 10-14 bright yellow rays, each 
with three notches at the end. Flower rays are irregularly 
bent back. The central disk is composed of tubular florets. 
Arnica blooms from June to August. The flowerheads, 
when crushed and sniffed, may cause sneezing, resulting 
in another of arnica’s common names: sneezewort. 


Arnica has a history of folk medicine use in many lo- 
cations, including North America, Germany, and Russian. 


The herb has been used in folk remedies since the six- 
teenth century. A North American indigenous tribe, the 
Cataulsa, prepared a tea from arnica roots to ease back 
pains. The German writer Goethe credited arnica with 
saving his life by bringing down a persistent high fever. 
Arnica preparations are used extensively in Russia. Folk 
use there includes external treatment of wounds, black 
eye, sprains, and contusions. Arnica has been used in 
Russian folk medicine to treat uterine hemorrhage, my- 
ocarditis, arteriosclerosis, angina pectoris, cardiac insuf- 
ficiency, and in numerous other unproven applications. 

General use 

Arnica flowers, fresh or dried, are used medicinally. 
Many herbalists consider arnica to be a specific remedy 
for bruises, sprains, and sore muscles. The herb is known 
by some as “tumbler’s cure all,” reflecting this common 
medicinal use. A compress soaked in an arnica infusion 
may relieve the inflammation of phlebitis. A few drops of 
arnica tincture added to warm water in a foot bath will re- 
lieve fatigue and soothe sore feet. A hair rinse prepared 
with arnica extract has been used to treat alopecia neuroti- 
ca, an anxiety condition leading to hair loss. The very di- 
lute homeopathic preparation ingested following a shock 
or muscle/soft tissue trauma is said to be beneficial. The 
homeopathic preparation is also used to relieve vertigo, 
hoarseness, and seasickness. Studies have determined that 
arnica has properties that act as an immunostimulant. The 
extract of arnica has been shown to stimulate the action of 
white blood cells in animal studies, increasing resistance 
to bacterial infections, such as salmonella. 

German studies have isolated sesquiterpenoid lac- 
tones, including helenalin and dihydrohelenalin, in arni- 
ca. These compounds were found to possess the pharma- 
cologic properties responsible for arnica’s anti-inflamma- 
tory and analgesic effects. Arnica contains sesquiterpene 
lactones, flavonoid glycosides, alkaloid, volatile oil, tan- 
nin, and isomeric alcohol, including arnidio and foradiol. 

Arnica is approved for external use as an anti-in- 
flammatory, analgesic, and antiseptic by the German 
Commission E, an advisory panel on herbal medicines. 
There are over one hundred medicinal preparations using 
arnica extracts commercially available in Germany. In 
the United States, arnica is widely used in topical appli- 
cation for bruises, aches, sprains, and inflammations. Ar- 
nica was listed in the U.S. Pharmacopeia from the early 
1800s until 1960. 


Arnica is available commercially in the form of lini- 
ments and massage oil for external application, and in 


very dilute homeopathic preparations considered safe for 
internal use. 

Harvest fully open arnica blossoms throughout the 
flowering season. Pick the flower heads on a sunny day 
after the morning dew has evaporated. Spread the blos- 
soms on a paper-lined tray to dry in a bright and airy room 
away from direct sun. Temperature in the drying room 
should be at least 70°F (21.1°C). When the blossoms are 
completely dry, store in a dark glass container with an air- 
tight lid. The dried herb will maintain medicinal potency 
for 12-18 months. Clearly label the container with the 
name of the herb and the date and place harvested. 

Tincture: Combine four ounces of fresh or dried ar- 
nica flowers with one pint of brandy, gin, or vodka in a 
glass container. The alcohol should be enough to cover 
the flowers. The ratio should be close to 50/50 alcohol to 
water. Stir and cover. Place the mixture in a dark cup- 
board for three to five weeks. Shake the mixture several 
times each day. Strain and store in a tightly capped, 
clearly labeled, dark glass bottle. Tinctures, properly pre- 
pared and stored, will retain medicinal potency for two 
years or more. Arnica tincture should not be ingested 
without supervision of a qualified herbalist or physician. 

Ointment: Simmer one ounce of dried and powdered 
arnica flowers with one ounce of olive oil for several 
hours on very low heat. Combine this medicinal oil with 
melted beeswax to desired consistency. Pour into dark 
glass jars while still warm. Seal with tightly fitting lids 
when cool and label appropriately. 

Infusion: Place two to three teaspoons of chopped, 
fresh arnica blossoms in a warmed glass container. Bring 
two cups of fresh, nonchlorinated water to the boiling 
point, add it to the herbs. Cover. Simmer for about 10 
minutes. Strain. The prepared tea will store for about two 
days in the refrigerator. The infusion may be used to 
bathe unbroken skin surfaces and to provide relief for 
rheumatic pain, chillbains, bruises, and sprains. Because 
of the toxicity of arnica, it is best to avoid internal use 
without qualified medical supervision. 


Arnica is deadly in large quantities. Do not ingest 
the herb or the essential oil. Do not use the undiluted es- 
sential oil externally. The extremely dilute homeopathic 
preparation of arnica is considered safe for internal use 
in proper therapeutic dosages. Overdose of arnica extract 
has resulted in poisoning, with toxic symptoms, such as 
vomiting, diarrhea, and hemorrhage, even death. Use 
externally with caution, and only in dilute preparations. 
Only the homeopathic tincture can be safely ingested. 
Discontinue if a skin rash results, and do not use on bro- 
ken skin. Research has confirmed that alcoholic extracts 




of arnica have a toxic action on the heart, and can cause 
an increase in blood pressure. 

Side effects 

Arnica contains a compound known as helenalin, an 
allergen that may cause contact dermatitis in some per- 
sons. If a rash develops discontinue use of the herbal 
preparation. Prolonged external use of arnica extract in 
high concentrations can result in blistering, skin ulcers, 
and surface necroses. 


None reported. 



Elias, Jason and Shelagh Ryan Masline. The A to Z Guide to 
Healing Herbal Remedies. Lynn Sonberg Book Associ- 
ates, 1996. 

Hoffmann, David. The New Holistic Herbal. 2d ed. Massachu- 
setts: Element, 1986. 

Kowalchik, Claire and William H. Hylton. Rodale's Illustrated 
Encyclopedia of Herbs. Pennsylvania: Rodale Press, 

Lust, John. The Herb Book. New York: Bantam Books, 1974. 

Magic And Medicine of Plants. The Reader's Digest Associa- 
tion, Inc. 1986. 

Meyer, Joseph E. The Herbalist. Clarence Meyer, 1973. 

Palaise, Jean. Grandmother’ s Secrets. Her Green Guide to 
Health From Plants. NY: G.P. Putnam's Sons, 1974. 

PDRfor Herbal Medicines. New Jersey: Medical Economics 
Company, 1998. 

Phillips, Roger and Nicky Foy. The Random House Book of 
Herbs. New York: Random House, Inc., 1990. 

Thomson, M.D., William A. R. Medicines From The Earth, A 
Guide to Healing Plants. San Francisco: Harper & Row, 

Tyler, Varro E., Ph.D. Herbs Of Choice, The Therapeutic Use 
of Phytomedicinals. New York: The Haworth Press, Inc., 

Tyler, Varro E., Ph.D. The Honest Herbal. New York: Pharma- 
ceutical Products Press, 1993. 


Grieve, Mrs. M. A Modern Herbal, Arnica, < 

Hoffmann, David L. Herbal Materia Medica, Hyssop. <http://> 

Clare Hanrahan 




Aromatherapy is the therapeutic use of plant-de- 
rived, aromatic essential oils to promote physical and 
psychological well-being. It is sometimes used in combi- 
nation with massage and other therapeutic techniques as 
part of a holistic treatment approach. 


Aromatic plants have been employed for their heal- 
ing, preservative, and pleasurable qualities throughout 
recorded history in both the East and West. As early as 
1500 B.c. the ancient Egyptians used waters, oils, in- 
cense, resins, and ointments scented with botanicals for 
their religious ceremonies. 

There is evidence that the Chinese may have recog- 
nized the benefits of herbal and aromatic remedies much 
earlier than this. The oldest known herbal text, Shen 
Nung's Pen Ts’ao (c. 2700-3000 B.c.) catalogs over 200 
botanicals. Ayurveda, a practice of traditional Indian 
medicine that dates back more than 2,500 years, also 
used aromatic herbs for treatment. 

The Romans were well known for their use of fra- 
grances. They bathed with botanicals and integrated them 
into their state and religious rituals. So did the Greeks, 
with a growing awareness of the medicinal properties of 
herbs. Greek physician and surgeon Pedanios Dioscorides, 
whose renown herbal text De Materia Medica (60 a.d.) 
was the standard textbook for Western medicine for 1,500 
years, wrote extensively on the medicinal value of botani- 
cal aromatics. The Medica contained detailed information 
on some 500 plants and 4,740 separate medicinal uses for 
them, including an entire section on aromatics. 

Written records of herbal distillation are found as 
early as the first century a.d., and around 1000 a.d., the 
noted Arab physician and naturalist Avicenna described 
the distillation of rose oil from rose petals, and the medi- 
cinal properties of essential oils in his writings. Howev- 
er, it wasn't until 1937, when French chemist Rene-Mau- 
rice Gattefosse published Aromatherapie : Les Huiles es- 
sentielles, hormones vege tales, that aromatherapie, or 
aromatherapy, was introduced in Europe as a medical 
discipline. Gattefosse, who was employed by a French 
perfumeur, discovered the healing properties of lavender 
oil quite by accident when he suffered a severe burn 
while working and used the closest available liquid, 
lavender oil, to soak it. 

In the late twentieth century, French physician Jean 
Valnet used botanical aromatics as a front line treatment 





Conditions treated 

Bay laurel 

Antiseptic, diuretic, sedative, etc. 

Digestive problems, bronchitis, common cold, influenza, 
and scabies and lice. CAUTION: Don't use if pregnant. 

Clary sage 

Relaxant, anticonvulsive, 
antiinflammatory, and antiseptic 

Menstrual and menopausal symptoms, burns, eczema, and 
anxiety. CAUTION: Don't use if pregnant. 


Antiseptic, antibacterial, astringent, 
expectorant, and analgesic 

Boils, breakouts, cough, common cold, influenza, and 
sinusitis. CAUTION: Not to be taken orally. 


Sedative, antiinflammatory, 
antiseptic, and pain reliever 

Hay fever, burns, acne, arthritis, digestive problems, 
and menstrual an menopausal symptoms. 


Analgesic, antiseptic, 

Headache, depression, insomnia, stress, sprains, and nausea. 


Pain reliever 

Indigestion, nausea, headache, motion sickness, and 
muscle pain. 


Antiseptic, stimulant, and diuretic 

Indigestion, gas, bronchitis, fluid retention, and influenza. 
CAUTION: Don't use if pregnant or have epilepsy or 


Diuretic, laxative, antispasmodic, 
and stimulant 

Menstrual and menopausal symptoms, gas, and indigestion. 
CAUTION: Don't use if pregnant. 

Tea tree 

Antiseptic and soothing 

Common cold, bronchitis, abscesses, acne, vaginitis, 
and burns. 


Stimulant, antiseptic, antibacterial, 
and antispasmodic 

Cough, laryngitis, diarrhea, gas, and intestinal worms. 
CAUTION: Don't use if pregnant or have hypertension. 

for wounded soldiers in World War II. He wrote about 
his use of essential oils and their healing and antiseptic 
properties, in his 1964 book Aromatherapie, traitement 
des maladies par les essences des plantes, which popu- 
larized the use of essential oils for medical and psychi- 
atric treatment throughout France. Later, French bio- 
chemist Mauguerite Maury popularized the cosmetic 
benefits of essential oils, and in 1977 Robert Tisserand 
wrote the first English language book on the subject. The 
Art of Aromatherapy, which introduced massage as an 
adjunct treatment to aromatherapy and sparked its popu- 
larity in the United Kingdom. 


Aromatherapy offers diverse physical and psycho- 
logical benefits, depending on the essential oil or oil 
combination and method of application used. Some 
common medicinal properties of essential oils used in 
aromatherapy include: analgesic, antimicrobial, anti- 
septic, anti-inflammatory, astringent, sedative, anti- 
spasmodic, expectorant, diuretic, and sedative. Essen- 
tial oils are used to treat a wide range of symptoms 
and conditions, including, but not limited to, gastroin- 
testinal discomfort, skin conditions, menstrual pain 


and irregularities, stress-related conditions, mood dis- 
orders, circulatory problems, respiratory infections, 
and wounds. 


In aromatherapy, essential oils are carefully selected 
for their medicinal properties. As essential oils are ab- 
sorbed into the bloodstream through application to the 
skin or inhalation, their active components trigger cer- 
tain pharmalogical effects (e.g., pain relief). 

In addition to physical benefits, aromatherapy has 
strong psychological benefits. The volatility of an oil, or 
the speed at which it evaporates in open air, is thought to 
be linked to its specific psychological effect. As a rule of 
thumb, oils that evaporate quickly are considered emo- 
tionally uplifting, while slowly-evaporating oils are 
thought to have a calming effect. 

Essential oils commonly used in aromatherapy treat- 
ment include: 

• Roman chamomile ( Chamaemelum nobilis). An anti- 
inflammatory and analgesic. Useful in treating otitis 
media (earache), skin conditions, menstrual pains, and 




Limbic system of the brain 

As a holistic therapy, aromatherapy is believed to benefit both the mind and body. Here, the aromatic substances from a 
flower stimulates the olfactory bulb and neurons. The desired emotional response (such as relaxation) is activated from the 
limbic system of the brain. (Illustration by Electronic Illustrators Group. The Gale Group) 

• Clary sage ( Salvia sclarea). This natural astringent is 
not only used to treat oily hair and skin, but is also said 
to be useful in regulating the menstrual cycle, improv- 
ing mood, and controlling high blood pressure. Clary 
sage should not be used by pregnant women. 

• Lavender ( Lavandula officinalis). A popular aromather- 
apy oil that mixes well with most essential oils, laven- 
der has a wide range of medicinal and cosmetic appli- 
cations, including treatment of insect bites, burns, res- 
piratory infections, intestinal discomfort, nausea, mi- 
graine, insomnia, depression, and stress. 

• Myrtle ( Myrtus communis). Myrtle is a fungicide, dis- 
infectant, and antibacterial. It is often used in steam 
aromatherapy treatments to alleviate the symptoms of 
whooping cough, bronchitis, and other respiratory in- 


• Neroli (bitter orange), ( Citrus aurantium). Citrus oil 
extracted from bitter orange flower and peel and used 
to treat sore throat, insomnia, and stress and anxiety- 
related conditions. 

• Sweet orange ( Citrus sinensis). An essential oil used to 
treat stomach complaints and known for its reported 
ability to lift the mood while relieving stress. 

• Peppermint ( Mentha piperita). Relaxes and soothes the 
stomach muscles and gastrointestinal tract. Peppennint’s 
actions as an anti-inflammatory, antiseptic, and antimi- 
crobial also make it an effective skin treatment, and use- 
ful in fighting cold and flu symptoms. In addition, re- 
search in 2002 found that peppermint scent helped ath- 
letes run faster and perform more push-ups than control 
subjects with odorless strips under their noses. 

• Rosemary ( Rosmarinus officinalis). Stimulating essential 
oil used to treat muscular and rheumatic complaints, as 


well as low blood pressure, gastrointestinal problems, and 
headaches. Recently. Brain scans have shown that fra- 
grance of rosemary increases blood circulation in the brain. 

• Tea tree (Melaleuca alternifolia). Has bactericidal, 
virucidal, fungicidal, and anti-inflammatory properties 
that make it a good choice for fighting infection. Rec- 
ommended for treating sore throat and respiratory in- 
fections, vaginal and bladder infections, wounds, and a 
variety of skin conditions. 

• Ylang ylang ( Cananga odorata). A sedative essential oil 
sometimes used to treat hypertension and tachycardia. 

Essential oils contain active agents that can have po- 
tent physical effects. While some basic aromatherapy 
home treatments can be self-administered, medical aro- 
matherapy should always be performed under the guid- 
ance of an aromatherapist, herbalist, massage therapist, 
nurse, or physician. 


The most basic method of administering aromather- 
apy is direct or indirect inhalation of essential oils. Sev- 
eral drops of an essential oil can be applied to a tissue or 
handkerchief and gently inhaled. A small amount of es- 
sential oil can also be added to a bowl of hot water and 
used as a steam treatment. This technique is recommend- 
ed when aromatherapy is used to treat respiratory and/or 
skin conditions. Aromatherapy steam devices are also 
available commercially. A warm bath containing essen- 
tial oils can have the same effect as steam aromatherapy, 
with the added benefit of promoting relaxation. When 
used in a bath, water should be lukewarm rather than hot 
to slow the evaporation of the oil. 

Essential oil diffusers, vaporizers, and light bulb 
rings can be used to disperse essential oils over a large 
area. These devices can be particularly effective in aro- 
matherapy that uses essential oils to promote a healthier 
home environment. For example, eucalyptus and tea tree 
oil are known for their antiseptic qualities and are fre- 
quently used to disinfect sickrooms, and citronella and 
geranium can be useful in repelling insects. 

Direct application 

Because of their potency, essential oils are diluted in a 
carrier oil or lotion before being applied to the skin to pre- 
vent an allergic skin reaction. The carrier oil can be a veg- 
etable or olive based one, such as wheat germ or avocado. 
Light oils, such as safflower, sweet almond, grapeseed, 
hazelnut, apricot seed, or peach kernel, may be absorbed 
more easily by the skin. Standard dilutions of essential oils 
in carrier oils range from 2-10%. However, some oils can 
be used at higher concentrations, and others should be di- 


luted further for safe and effective use. The type of carrier 
oil used and the therapeutic use of the application may also 
influence how the essential oil is mixed. Individuals should 
seek guidance from a healthcare professional and/or aro- 
matherapist when diluting essential oils. 

Massage is a common therapeutic technique used in 
conjunction with aromatherapy to both relax the body and 
thoroughly administer the essential oil treatment. Essen- 
tial oils can also be used in hot or cold compresses and 
soaks to treat muscle aches and pains (e.g., lavender and 
ginger). As a sore throat remedy, antiseptic and soothing 
essential oils (e.g., tea tree and sage) can be thoroughly 
mixed with water and used as a gargle or mouthwash. 

Internal use 

Some essential oils can be administered internally in 
tincture, infusion, or suppository form to treat certain 
symptoms or conditions; however, this treatment should 
never be self-administered. Essential oils should only be 
taken internally under the supervision of a qualified 
healthcare professional. 

As non-prescription botanical preparations, the es- 
sential oils used in aromatherapy are typically not paid 
for by health insurance. The self-administered nature of 
the therapy controls costs to some degree. Aromatherapy 
treatment sessions from a professional aromatherapist 
are not covered by health insurance in most cases, al- 
though aromatherapy performed in conjunction with 
physical therapy, nursing, therapeutic massage, or other 
covered medical services may be covered. Individuals 
should check with their insurance provider to find out 
about their specific coverage. 

The adage “You get what you pay for” usually ap- 
plies when purchasing essential oils, as bargain oils are 
often adulterated, diluted, or synthetic. Pure essential 
oils can be expensive; and the cost of an oil will vary de- 
pending on its quality and availability. 


The method of extracting an essential oil varies by 
plant type. Common methods include water or steam dis- 
tillation and cold pressing. Quality essential oils should be 
unadulterated and extracted from pure botanicals. Many 
aromatherapy oils on the market are synthetic and/or dilut- 
ed, contain solvents, or are extracted from botanicals 
grown with pesticides or herbicides. To ensure best re- 
sults, essential oils should be made from pure organic 
botanicals and labeled by their full botanical name. Oils 
should always be stored in dark bottles out of direct light. 

Before using essential oils on the skin, individuals 
should perform a skin patch test by applying a small amount 




of the diluted oil behind the wrist and covering it with a ban- 
dage or cloth for up to 12 hours. If redness or irritation oc- 
curs, the oil should be diluted further and a second skin test 
performed, or it should be avoided altogether. Individuals 
should never apply undiluted essential oils to the skin unless 
advised to do so by a trained healthcare professional. 


Individuals should only take essential oils internally 
under the guidance and close supervision of a health care 
professional. Some oils, such as eucalyptus, wormwood, 
and sage, should never be taken internally. Many essential 
oils are highly toxic and should not be used at all in aro- 
matherapy. These include (but are not limited to) bitter al- 
mond, pennyroyal, mustard, sassafras, rue, and mugwort. 

Citrus-based essential oils, including bitter and 
sweet orange, lime, lemon, grapefruit, and tangerine, are 
phototoxic, and exposure to direct sunlight should be 
avoided for at least four hours after their application. 

Other essential oils, such as cinnamon leaf, black 
pepper, juniper, lemon, white camphor, eucalyptus blue 
gum, ginger, peppermint, pine needle, and thyme can be 
extremely irritating to the skin if applied in high enough 
concentration or without a carrier oil or lotion. Caution 
should always be exercised when applying essential oils 
topically. Individuals should never apply undiluted es- 
sential oils to the skin unless directed to do so by a 
trained healthcare professional and/or aromatherapist. 

Individuals taking homeopathic remedies should 
avoid black pepper, camphor, eucalyptus, and pepper- 
mint essential oils. These oils may act as a remedy anti- 
dote to the homeopathic treatment. 

Children should only receive aromatherapy treat- 
ment under the guidance of a trained aromatherapist or 
healthcare professional. Some essential oils may not be 
appropriate for treating children, or may require addi- 
tional dilution before use on children. 

Certain essential oils should not be used by pregnant 
or nursing women or by people with specific illnesses or 
physical conditions. Individuals suffering from any chron- 
ic or acute health condition should inform their healthcare 
provider before starting treatment with any essential oil. 

Asthmatic individuals should not use steam inhala- 
tion for aromatherapy, as it can aggravate their condition. 

Essential oils are flammable, and should be kept 
away from heat sources. 

Side effects 

Side effects vary by the type of essential oil used. 
Citrus-based essential oils can cause heightened sensitiv- 
ity to sunlight. Essential oils may also cause contact 


dermatitis, an allergic reaction characterized by redness 
and irritation. Anyone experiencing an allergic reaction 
to an essential oil should discontinue its use and contact 
their healthcare professional for further guidance. Indi- 
viduals should do a small skin patch test with new essen- 
tial oils before using them extensively. 

Research & general acceptance 

The antiseptic and bactericidal qualities of some es- 
sential oils (such as tea tree and peppermint) and their 
value in fighting infection has been detailed extensively 
in both ancient and modern medical literature. 

Recent research in mainstream medical literature 
has also shown that aromatherapy has a positive psycho- 
logical impact on patients. Several clinical studies in- 
volving both post-operative and chronically ill subjects 
showed that massage with essential oils can be helpful in 
improving emotional well-being, and consequently, pro- 
moting the healing process. 

Today, the use of holistic aromatherapy is widely ac- 
cepted in Europe, particularly in Great Britain, where it 
is commonly used in conjunction with massage as both a 
psychological and physiological healing tool. In the 
United States, where aromatherapy is often misunder- 
stood as solely a cosmetic treatment, the mainstream 
medical community has been slower to accept its use. 

Training & certification 

Certification or licensing is currently not required to 
become an aromatherapist in the United States; however, 
many states require that healthcare professionals who 
practice the “hands-on” therapies often used in conjunc- 
tion with aromatherapy (e.g., massage) to be licensed. 
There are state-licensed educational institutions that 
offer certificates and/or diplomas in aromatherapy train- 
ing. Individuals interested in aromatherapy treatment 
from a professional aromatherapist may be able to obtain 
a referral from one of these institutions, or from their 
current healthcare provider. 



Lawless, Julia. The Complete Illustrated Guide To Aromathera- 
py. Rockport, MA: Element Books Ltd, 1997. 

Schnaubelt, Kurt. Medical Aromatherapy: Healing With Essen- 
tial Oils. Berkeley, CA: Frog Ltd, 1999. 



Claps, Frank.“Training Scents: You May be Able to Sniff Your 
Way to Better Workouts with Tricks from the Aromathera- 
pist's Bag.” Men's Fitness (May 2002):34. 



Antiseptic — Inhibits the growth of microorgan- 

Bactericidal — An agent that destroys bacteria 
(e.g., Staphylococci aureus, Streptococci pneumo- 
niae, Escherichia coli, Salmonella enteritidis). 
Carrier oil — An oil used to dilute essential oils for 
use in massage and other skin care applications. 

Contact dermatitis — Skin irritation as a result of 
contact with a foreign substance. 

Essential oil — A volatile oil extracted from the 
leaves, fruit, flowers, roots, or other components 
of a plant and used in aromatherapy, perfumes, 
and foods and beverages. 

Holistic — A practice of medicine that focuses on 
the whole patient, and addresses the social, emo- 
tional, and spiritual needs of a patient as well as 
their physical treatment. 

Phototoxic — Causes a harmful skin reaction when 
exposed to sunlight. 

Remedy antidote — Certain foods, beverages, pre- 
scription medications, aromatic compounds, and 
other environmental elements that counteract the 
efficacy of homeopathic remedies. 

Steam distillation — A process of extracting essen- 
tial oils from plant products through a heating and 
evaporation process. 

Volatile — Something that vaporizes or evaporates 
quickly when exposed to air. 

Stanten, Michele, and Selene Yeager.“Smell this for Instant En- 
ergy: the Easiest Way to Boost your Workouts. (Fitness 
News).” Prevention (April 2002):76. 

National Association of Holistic Aromatherapy. 836 Hanley In- 
dustrial Court, St. Louis, MO 63144. 888-ASK-NAHA. 

Paula Ford-Martin 
Teresa G. Odle 



Growing to a height of up to 6 ft (2 m), arrowroot is 
a tropical perennial with clusters of long, thin stems and 


small, cream-colored flowers that grow in pairs. Once 
revered by the ancient Mayans and other inhabitants of 
Central America as an antidote for poison-tipped arrows, 
the herb is mainly used today to soothe the stomach and 
alleviate diarrhea. It has also been popular for centuries 
in the culinary arts and is still used in many American 
kitchens as a thickening agent. While arrowroot is native 
to Central America and widely cultivated in the West In- 
dies, it can also be found growing in many tropical re- 
gions of the world, including Southeast Asia, South 
Africa, Australia, and in Florida in the United States. 
The Latin genus Maranta was derived from the name of 
an Italian doctor, Bartommeo Maranto. 

Arrowroot, which belongs to the Marantaceae plant 
family, is widely considered an easily digested and nutri- 
tious starch. The herb is extracted from the fleshy roots, 
called rhizomes, of the arrowroot plant through an elabo- 
rate process of washing, peeling, soaking, and drying in 
the sun. The end product is a fine, white powder with the 
same appearance and texture as cornstarch. Arrowroot is 
valued by herbalists primarily for its demulcent and an- 
tidiarrheal properties. Exactly how it produces its thera- 
peutic effects is not known. The chemical composition of 
the herb has not been thoroughly investigated. 

While only Maranta arundinacea is considered true 
arrowroot, the common name for the herb is often ap- 
plied to a variety of starches. These include other species 
of Maranta , such as Maranta ramosissima, Maranta al- 
louya, Maranta nobilis, as well as Brazilian arrowroot 
(Manihot utilissima or Manihot palmate), Tahitian ar- 
rowroot ( Tacca oceanica), and East Indian arrowroot 
( Curcuma augustifolia ). While some of these starches 
may be chemically similar to true arrowroot, it is not 
clear if they produce the same medicinal effects. Con- 
sumers interested in trying arrowroot are advised to 
choose Maranta arundinacea , which is sometimes re- 
ferred to as West Indian arrowroot or simply Maranta. 

As of 2000, much research is still required to deter- 
mine if arrowroot can produce significant health benefits 
safely and effectively. The proper dosage of the herb has 
also yet to be determined. 

General use 

While not approved by the United States Food and 
Drug Administration (FDA), arrowroot is thought to 
have several beneficial effects. However, there is little 
scientific evidence to support these claims. Today, the 
herb is primarily used to soothe an uneasy stomach and 
alleviate diarrhea or nausea and vomiting. Since it con- 
tains calcium and carbohydrates as well as other nutri- 
ents, arrowroot is also used as an easily digested source 
of nutrition for infants, people recovering from illnesses 



Arsenicum album 

(especially those with bowel problems), and those on re- 
stricted diets . The herb is considered easier on the stom- 
ach than other forms of starch. 

Because arrowroot has not been studied extensively in 
people or animals, its effectiveness is based mainly on its 
reputation as a folk remedy. Despite the lack of scientific ev- 
idence, some practitioners of alternative medicine consider it 
useful for certain conditions. Alternative physicians praise 
the stomach-soothing powers of arrowroot as well as its nu- 
tritional value. Another prominent herbalist recommends ar- 
rowroot for preventing athlete’s foot. Putting the dried pow- 
der inside socks and shoes can help to combat the moisture 
that contributes to the growth of foot fungus. However, ar- 
rowroot is not known to have antifungal properties. 

Arrowroot was popular in the past as an antidote for 
arrow poison. It also had a reputation as a treatment for 
scorpion and spider bites as well as gangrene. However, 
there is no scientific evidence to support these uses. In 
cases of poisoning, the local poison control center or an 
emergency care center should be contacted immediately. 

Aside from its medicinal uses, arrowroot is still used 
in cooking. Much like cornstarch, arrowroot is used as a 
thickener for sauces, soups, and confections. 


The optimum daily dosage of arrowroot has not 
been established with any certainty. Consumers should 
follow the package directions for proper use or consult a 
doctor experienced in the use of alternative remedies. 
Arrowroot powder, which is basically flavorless, is often 
mixed with juice or other beverages before ingestion. 


Arrowroot is not known to be harmful when taken in 
recommended dosages. However, it is important to re- 
member that the long-term effects of taking the herb ( in 
any amount) have not been investigated. Due to the lack 
of sufficient medical research, arrowroot should be used 
with caution in children, women who are pregnant or 
breast-feeding, and people with liver or kidney disease. 

People who experience vomiting or severe/pro- 
longed diarrhea may be prone to dehydration. They 
should drink plenty of water (six to eight glasses a day) 
in order to maintain a proper fluid balance. A doctor 
should be consulted if the vomiting or diarrhea lasts 
longer than three days or is accompanied by other symp- 
toms such as pain or fever. 

Side effects 

When taken in recommended dosages, arrowroot is 
not associated with any significant side effects. 



Calcium — A mineral necessary for strong bones 
and the proper functioning of organs and muscles. 

Demulcent — A gelatinous or oily substance that 
has a protective or soothing influence on irritated 
mucous membranes. 

Gangrene — Localized tissue death caused by lack 
of blood. 

Rhizome — A relatively long and thick plant root 
that can be distinguished from normal roots by the 
presence of buds, nodes, or other characteristics. 


Arrowroot is not known to interact adversely with 
any drug or dietary supplement. It has been combined 
with milk, lemon and other fruit juices, sugar, and wine 
without apparent harm. 

To avoid constipation, consumers should not take 
aiTowroot with other medications or dietary supplements 
used to alleviate diarrhea. 



Gruenwald, Joerg. PDR for Herbal Medicines. New Jersey: 
Medical Economics, 1998. 


Rolston D. D., P. Mathew, and V. I. Mathan. “Food-Based So- 
lutions Are a Viable Alternative to Glucose-Electrolyte 
Solutions for Oral Hydration in Acute Diarrhoea-Studies 
in a Rat Model of Secretory Diarrhoea.” Transactions of 
the Royal Society of Tropical Medicine and Hygiene 84, 
no. 1 (1990): 156-159. 


American Botanical Council. P.O. Box 144345, Austin, TX 

OTHER <>. 

Greg Annussek 

Arsenicum album 


Arsenicum album is a homeopathic remedy derived 
from the metallic element arsenic. Traces of arsenic are 


found in vegetables and animals. In its crude form, arsenic 
is poisonous. Gradual accumulations may result in diges- 
tive disturbances, nausea, vomiting, diarrhea, dehydra- 
tion, coma, shock, convulsions, paralysis, and death. 

Common names for arsenicum album include ar- 
senic trioxide, white arsenic, white oxide of metallic ar- 
senic, and arsenius acid. Arsenic is indestructible, even 
by fire, and remains in bone ash after cremation. It has 
been used to create pigmentation for wallpaper, carpet, 
and paints. Arsenic has also been used to produce medi- 
cines and pesticides. 

Arsenic was used as a remedy for certain types of 
cattle disease as far back as the eighth century. In the 
seventeenth century, arsenic was applied topically to 
treat malignant ulcers and skin diseases in humans. 
Taken internally, it was used to treat fevers. When fre- 
quent and repeated doses of arsenic resulted in poisoning 
and death, arsenic was pronounced unsafe for use. How- 
ever, housewives and practitioners still used arsenic and 
were often successful in their treatments. Eventually ar- 
senic use was reinstated. Weak compounds of arsenic 
were often used to increase strength and endurance, rem- 
edy anemia, and improve the skin and fur of animals. An 
ointment made from arsenic was used to treat cancerous 
growths and tumors. 

General use 

Arsenicum album is one of the most frequently used 
homeopathic remedies and is one of the most well- 
proven remedies. A polychrest with a wide field of ac- 
tion, arsenicum album has the power to affect all parts of 
the human body. 

Arsenicum album is used to treat serious acute ail- 
ments, chronic diseases, and acute colds, bronchitis, and 
fevers. Homeopaths prescribe this remedy to treat asthma, 
anxiety disorders, panic attacks, skin infections, boils, 
burns with blisters, cystitis, eye inflammations, chicken- 
pox, colds, coughs, indigestion, Crohn’s disease, herpes 
simplex, flu, insomnia, measles, mumps, sore throats, al- 
lergies and hay fever, food poisoning, and fevers. Ar- 
senicum album has also been used to treat malarial and 
septic infections, alcoholism, syphilis, lupus, and cancer 
(when applied in the early stages of the disease). 

Arsenicum album illnesses can be brought about by 
the use of quinine, tobacco, or alcohol, or from the sup- 
pression of skin eruptions, sweat, or mucous membrane 

Common characteristics 

People requiring arsenicum album generally fit a 
particular profile. They are anxious, restless, weak, pale, 


emaciated, faint, chilled, and catch colds easily. Their 
eyes are sunken and glassy; their faces is yellowish or 
ashy pale, and mouth, lips, and tongue are parched and 
dry. They desire liquids in small, frequent amounts. The 
forehead, face, chest, knees, hands, and feet are often 
cold, so patients crave warmth. They may suffer from 
burning, pressing pains throughout the entire body. 
These pains are aggravated by cold and reduced by heat. 
Weakness is sudden and is reduced by lying down, al- 
though the other symptoms are worsened by it. 

Other physical characteristics of this remedy include 
burning, offensive, and watery discharges; palpitations; 
profuse, sour sweat; and a red-tipped tongue. There is a 
tendency to bleed easily and from any place, and vomit- 
ing of blood and bleeding from lungs, throat, and mu- 
cous membranes are not uncommon. 

The mental and emotional symptoms of the patient 
profile also include anxiety, nervousness, suspicion, im- 
pulsiveness, irritability, sadness, hopelessness, and de- 
pression. People requiring this remedy are often difficult 
patients. They are critical and argumentative, easily of- 
fended, easily startled, insecure, forgetful, sensitive to 
pain, and often suffer from delusions or hallucinations. 
They think their ailment is more serious than it is and de- 
spair of ever getting well, often fearing that they are 
going to die. They desire company and are afraid of 
being alone. Patients may be unable to sleep due to their 
restlessness and anxiety or from physical discomforts 
such as fever or cough. When they do sleep, they may 
have anxious dreams or nightmares. Even though they 
are extremely weak, arsenicum album patients are clean 
and tidy, partially to relieve their restlessness. 

The symptoms are aggravated by a change in tem- 
perature, wet weather, cold food and drink, and by the 
slightest exertion. They are worse after midnight, upon 
waking, with alcohol use, and during menstruation. 
Symptoms are improved by heat, hot beverages, the 
warmth of the bed, fresh air, and lying down. 

Arsenicum album is a useful remedy for mental dis- 
orders with symptoms of melancholy, irritation, intense 
anxiety, and restlessness. The patient may be prone to vi- 
olent fits of anger or rage or have an impulse to commit 
murder. It also can have a positive effect on alcoholism 
and can improve diarrhea, weakness, stomach irritation, 
and emaciation. 

Specific indications 

Arsenicum album can be used for the following con- 

• Throbbing, frontal headaches. These are accompanied 
by a flushed or hot face, heat or burning inside the 
head, and a feeling that the head will explode. These 


Arsenicum album 

Art therapy 

headaches occur with regularity and are reduced by 
cool air or cold applications. 

• Herpetic or eczematous skin eruptions. These are 
moist, scabby, pustular, itching, or burning. 

• Hot, burning fevers. These sometimes alternate with 
chills. Fevers are worse at night, particularly after mid- 

• Sore throat. It is accompanied by burning pain that is 
worse from swallowing or cold drinks and is reduced 
with hot drinks. 

• Hacking coughs. These are frequently dry at night and 
are relieved by hot drinks. They are worsened by the 
cold, by fresh air, when lying down, at night (particu- 
larly after midnight), and during a fever. 

• Chronic nasal congestion. This is often accompanied 
by bleeding, constant sneezing, chills, fatigue, restless- 
ness, anxiety at night, troublesome dreams, and crusts 
in the back of the nose. 


The homeopathic remedy is prepared by separating 
arsenic from iron, cobalt, and nickel when the minerals 
are baked at high temperatures. The powder is then 
ground and diluted with milk sugar. 

Arsenicum album is available at health food and 
drug stores in various potencies in the form of tinctures, 
tablets, and pellets. 


If symptoms do not improve after the recommended 
time period, a homeopath or healthcare practitioner 
should be consulted. 

Consumers are advised not to exceed the recom- 
mended dose. 

Side effects 

There are no side effects currently reported. 


When taking any homeopathic remedy, consumers 
should not use peppermint products, coffee, or alcohol. 
These products may cause the remedy to be ineffective. 



Cummings, Stephen, M.D., and Ullman, Dana, M.P.H. Every- 
body’s Guide to Homeopathic Medicines. New York: Jere- 
my P. Tarcher/Putnam, 1997. 



Polychrest — A homeopathic remedy that is used 
to treat many ailments. 

Pustular — Resembling a blister and usually con- 
taining pus. 

Kent, James Tyler. Lectures on Materia Medica. Delhi. India: 
B. Jain Publishers, 1996. 

Jennifer Wurges 

Arthritis see Osteoarthritis; Rheumatoid 

Art therapy 


Art therapy, sometimes called creative arts therapy 
or expressive arts therapy, encourages people to express 
and understand emotions through artistic expression and 
through the creative process. 


Humans have expressed themselves with symbols 
throughout history. Masks, ritual pottery, costumes, other 
objects used in rituals, cave drawings, Egyptian hiero- 
glyphics, and Celtic art and symbols are all visual 
records of self-expression and communication through 
art. Art has also been associated spiritual power, and 
such artistic forms as the Hindu and Buddhist mandala 
and Native American sand painting are considered pow- 
erful healing tools. 

In the late nineteenth century, French psychiatrists 
Ambrose Tardieu and Paul-Max Simon both published 
studies on the similar characteristics of and symbolism 
in the artwork of the mentally ill. Tardieu and Simon 
viewed art therapy as an effective diagnostic tool to iden- 
tify specific types of mental illness or traumatic events. 
Later, psychologists would use this diagnostic aspect to 
develop psychological drawing tests (the Draw-A-Man 
test, the Draw-A-Person Questionnaire [DAP.Q]) and 
projective personality tests involving visual symbol 
recognition (e.g., the Rorschach Inkblot Test, the The- 
matic Apperception Test [TAT], and the Holtzman 
Inkblot Test [HIT]). 


The growing popularity of milieu therapies at psy- 
chiatric institutions in the twentieth century was an im- 
portant factor in the development of art therapy in the 
United States. Milieu therapies (or environmental ther- 
apy) focus on putting the patient in a controlled thera- 
peutic social setting that provides the patient with oppor- 
tunities to gain self-confidence and interact with peers in 
a positive way. Activities that encourage self-discovery 
and empowerment such as art, music, dance, and writing 
are important components of this approach. 

Educator and therapist Margaret Naumburg was a 
follower of both Freud and Jung, and incorporated art 
into psychotherapy as a means for her patients to visual- 
ize and recognize the unconscious. She founded the 
Walden School in 1915, where she used students’ art- 
works in psychological counseling. She published exten- 
sively on the subject and taught seminars on the tech- 
nique at New York University in the 1950s. Today, she is 
considered the founder of art therapy in the United States. 

In the 1930s, Karl, William, and Charles Menninger 
introduced an art therapy program at their Kansas-based 
psychiatric hospital, the Menninger Clinic. The Men- 
ninger Clinic employed a number of artists in residence 
in the following years, and the facility was also consid- 
ered a leader in the art therapy movement through the 
1950s and 60s. Other noted art therapy pioneers who 
emerged in the 50s and 60s include Edith Kramer, Hanna 
Yaxa Kwiatkowska (National Institute of Mental 
Health), and Janie Rhyne. 


Art therapy provides the client-artist with critical in- 
sight into emotions, thoughts, and feelings. Key benefits 
of the art therapy process include: 

• Self-discovery. At its most successful, art therapy trig- 
gers an emotional catharsis. 

• Personal fulfillment. The creation of a tangible reward 
can build confidence and nurture feelings of self-worth. 
Personal fulfillment comes from both the creative and 
the analytical components of the artistic process. 

• Empowerment. Art therapy can help people visually 
express emotions and fears that they cannot express 
through conventional means, and can give them some 
sense of control over these feelings. 

• Relaxation and stress relief. Chronic stress can be 
harmful to both mind and body. Stress can weaken and 
damage the immune system, can cause insomnia and 
depression, and can trigger circulatory problems (like 
high blood pressure and irregular heartbeats). When 
used alone or in combination with other relaxation 


Art therapist with students. (Peter Berndt. Custom Medical 
Stock Photo, Inc. Reproduced by permission.) 

techniques such as guided imagery, art therapy can ef- 
fectively relieve stress. 

• Symptom relief and physical rehabilitation. Art therapy 
can also help patients cope with pain. This therapy can 
promote physiological healing when patients identify and 
work through anger, resentment, and other emotional 
stressors. It is often prescribed to accompany pain control 
therapy for chronically and terminally ill patients. 


Art therapy, sometimes called expressive art or art 
psychology, encourages self-discovery and emotional 
growth. It is a two part process, involving both the cre- 
ation of art and the discovery of its meaning. Rooted in 
Freud and Jung’s theories of the subconscious and un- 
conscious, art therapy is based on the assumption that vi- 
sual symbols and images are the most accessible and nat- 
ural form of communication to the human experience. 
Patients are encouraged to visualize, and then create, the 
thoughts and emotions that they cannot talk about. The 
resulting artwork is then reviewed and its meaning inter- 
preted by the patient. 

The “analysis” of the artwork produced in art thera- 
py typically allows patients to gain some level of insight 


Art therapy 

Art therapy 

into their feelings and lets them to work through these is- 
sues in a constructive manner. Art therapy is typically 
practiced in conjunction with individual, group, or fami- 
ly psychotherapy (talk therapy). While a therapist may 
provide critical guidance for these activities, a key fea- 
ture of effective art therapy is that the patient/artist, not 
the therapist, directs the interpretation of the artwork. 

Art therapy can be a particularly useful treatment 
tool for children, who frequently have limited language 
skills. By drawing or using other visual means to express 
troublesome feelings, younger patients can begin to ad- 
dress these issues, even if they cannot identify or label 
these emotions with words. Art therapy is also valuable 
for adolescents and adults who are unable or unwilling to 
talk about thoughts and feelings. 

Beyond its use in mental health treatment, art thera- 
py is also used with traditional medicine to treat organic 
diseases and conditions. The connection between mental 
and physical health is well documented, and art therapy 
can promote healing by relieving stress and allowing the 
patient to develop coping skills. 

Art therapy has traditionally centered on visual 
mediums, like paintings, sculptures, and drawings. Some 
mental healthcare providers have now broadened the def- 
inition to include music, film, dance, writing, and other 
types of artistic expression. 

Art therapy is often one part of a psychiatric inpatient 
or outpatient treatment program, and it can take place in 
individual or group therapy sessions. Group art therapy 
sessions often take place in hospital, clinic, shelter, and 
community program settings. These group therapy ses- 
sions can have the added benefits of positive social inter- 
action, empathy, and support from peers. The client-artist 
can learn that others have similar concerns and issues. 


Before starting art therapy, the therapist may have an 
introductory session with the client-artist to discuss art 
therapy techniques and give the client the opportunity to 
ask questions about the process. The client-artist’s comfort 
with the artistic process is critical to successful art therapy. 

The therapist ensures that appropriate materials and 
space are available for the client-artist, as well as an ade- 
quate amount of time for the session. If the individual 
artist is exploring art as therapy without the guidance of a 
trained therapist, adequate materials, space, and time are 
still important factors in a successful creative experience. 

The supplies used in art therapy are limited only by the 
artist’s (and/or therapist’s) imagination. Some of the materi- 
als often used include paper, canvas, poster board, assorted 
paints, inks, markers, pencils, charcoals, chalks, fabrics, 


string, adhesives, clay, wood, glazes, wire, bendable metals, 
and natural items (like shells, leaves, etc.). Providing artists 
with a variety of materials in assorted colors and textures 
can enhance their interest in the process and may result in a 
richer, more diverse exploration of their emotions in the re- 
sulting artwork. Such appropriate tools as scissors, brushes, 
erasers, easels, supply trays, glue guns, smocks or aprons, 
and cleaning materials are also essential. 

An appropriate workspace should be available for the 
creation of art. Ideally, this should be a bright, quiet, com- 
fortable place, with large tables, counters, or other suitable 
surfaces. The space can be as simple as a kitchen or office 
table, or as fancy as a specialized artist’s studio. 

The artist should have adequate time to become 
comfortable with and explore the creative process. This 
is especially true for people who do not consider them- 
selves “artists” and may be uncomfortable with the con- 
cept. If performed in a therapy group or one-on-one ses- 
sion, the art therapist should be available to answer gen- 
eral questions about materials and/or the creative 
process. However, the therapist should be careful not to 
influence the creation or interpretation of the work. 


Art materials and techniques should match the age 
and ability of the client. People with impairments, such 
as traumatic brain injury or an organic neurological con- 
dition, may have difficulties with the self-discovery por- 
tion of the art therapy process depending on their level of 
functioning. However, they may still benefit from art 
therapy through the sensory stimulation it provides and 
the pleasure they get from artistic creation. 

While art is accessible to all (with or without a ther- 
apist to guide the process), it may be difficult to tap the 
full potential of the interpretive part of art therapy with- 
out a therapist to guide the process. When art therapy is 
chosen as a therapeutic tool to cope with a physical con- 
dition, it should be treated as a supplemental therapy and 
not as a substitute for conventional medical treatments. 

Research & general acceptance 

A wide body of literature supports the use of art 
therapy in a mental health capacity. And as the mind- 
body connection between psychological well-being and 
physical health is further documented by studies in the 
field, art therapy gains greater acceptance by mainstream 
medicine as a therapeutic technique for organic illness. 

Training & certification 

Both undergraduate and graduate art therapy pro- 
grams are offered at many accredited universities across 



Catharsis — Therapeutic discharge of emotional 
tension by recalling past events. 

Mandala — A design, usually circular, that appears 
in religion and art. In Buddhism and Hinduism, 
the mandala has religious ritual purposes and 
serves as a yantra (a geometric emblem or instru- 
ment of contemplation). 

Organic illness — A physically, biologically based 

the United States. Typical art therapy programs combine 
courses in art and psychology. The majority of these pro- 
grams meets or exceeds standards set by the American 
Art Therapy Association (AATA). 

The Art Therapy Credentials Board (ATCB), a volun- 
tary organization, grants the designation ATR (Art Thera- 
pist Registered) to professionals who have completed an 
approved master’s level program of study in art therapy 
(as described by the AATA) and have accumulated at least 
1,000 hours of additional supervised clinical experience. 
Board certification is also available through the ATCB for 
art therapists who have met the ATR requirements and 
have passed a certification exam (ATR-BC). Art therapists 
with the ATR-BC designation must complete continuing 
education credits to maintain their certification. 

Registration and/or certification is a recognition of 
professional expertise, not a legal qualification or re- 
quirement to practice. Professional licensing require- 
ments for art therapists vary by state. However, if the 
therapy is intended as a companion treatment to psycho- 
logical counseling or other mental health treatment, state 
licensing requirements typically apply. Where licensing 
is a prerequisite to practice, a combination of education 
and clinical experience, a written test, and continuing ed- 
ucation are required to maintain the license. 



Fausek, Diane. A Practical Guide to Art Therapy. Binghamton. 

New York: Haworth Press, 1997. 

Ganim, Barbara. Art and Healing: Using expressive art to heal 
your body, mind, and spirit. New York: Three Rivers 
Press, 1999. 

Malchiodi, Cathy A. The Art Therapy Sourcebook. Los Ange- 
les: Lowell House, 1998. 

McNiff, Shaun. Art as Medicine: Creating a Therapy of the 
Imagination. Boston: Shambhala, 1992. 



American Art Therapy Association. 1202 Allanson Rd., 
Mundelein, IL 60060-3808. 888-290-0878 or 847-949- 
6064. Fax: 847-566-4580. E-mail: 
w w w.arttherapy . org . 

Paula Ford-Martin 

Ascorbic acid see Vitamin C 



Ashwaganda, also spelled ashwagandha, is a member 
of the pepper family known as Withania somnifera. The 
small evergreen grows in the frost-free drier parts of west- 
ern India, northern Africa, the Mediterranean, and the 
Middle East. Ashwaganda grows to a height of 2-3 ft 
(about 1 m) and has oval leaves, showy yellow flowers, 
and red, raisin-sized fruits. All parts of the plant, including 
the root, are used medicinally. Ashwaganda is also called 
winter cherry, withania, asgandh, and Indian ginseng. 

General use 

Ashwaganda is a major herb in the Ayurvedic sys- 
tem of health and healing. Ayurvedic medicine is a sys- 
tem of individualized healing derived from Hinduism 
that has been practiced in India for more than 2,000 
years. It is a complex system that recognizes different 
human temperaments and body types. Each of these 
types has different qualities that affect a person’s health 
and natural balance. 

In Ayurvedic medicine, disease can result from any 
of seven major categories of factors: heredity, congenital, 
internal, external trauma, seasonal, habits, or supernatur- 
al factors. Disease can also be caused by misuse of the 
five senses: sight, touch, taste, hearing, and smell. Diag- 
noses are made through questioning, observation, exami- 
nation, and interpretation. Health is restored by evaluat- 
ing the exact cause of the imbalance causing the disease 
or condition and then prescribing herbs, exercises, diet 
changes and/or meditation to help restore the natural 
balance of body, mind, and spirit. Prescriptions are high- 
ly individualized, so that the same symptoms may re- 
quire different remedies in different people. 

Ashwaganda is used to treat a great many different 
conditions in Ayurvedic medicine. Every part of the plant 
is used: leaves, fruit, flowers, and root. In addition, the 




Ashwaganda plant. (© PlantaPhile, Germany. Reproduced by 

young shoots and seeds are used as food and to thicken 
plant milks in the making of vegan cheeses. The fruit can 
be used as a substitute for soap, and the leaves are some- 
times used as an insect repellent. Although ashwaganda 
can be taken alone, it is more often combined with other 
herbs in tonics to enhance its rejuvenating effects. 

Indian ginseng 

Ashwaganda is sometimes called the Indian ginseng 
because its actions and uses are in many ways similar to 
those of Chinese ginseng, although its cost is much 
lower. In Hindi, the name of ashwaganda means “horse 
smell.” This name refers less to the herb’s odor than to a 
horse’s strength and health. Ashwaganda is supposed to 
impart that same horse-like strength to the people who 
use it. 

Ashwaganda is an adaptogen. Adaptogens are sub- 
stances that non-specifically enhance and regulate the 
body’s ability to withstand stress and increase its general 
performance in ways that help the whole body resist dis- 
ease. Ashwaganda is celebrated as an adaptogen that will 
do all of the following: 

• boost strength 

• increase stamina and relieve fatigue 

• enhance sexual energy and rejuvenate the body 

• strengthen the immune system 

• speed recovery from chronic illness 

• strengthen sickly children 

• soothe and calm without producing drowsiness 

• clarify the mind and improve memory 

• slow the aging process 

The powdered root of ashwaganda is normally used 
for whole body tonics that improve general health and well 
being. For most of these uses, ashwaganda is prepared as 
part of a rasayana , or rejuvenating formula that contains 
many different herbs. The use of ashwaganda in multi-herb 
formulas makes it difficult for modern laboratory scientists 
to assess its specific effects as an adaptogen. 

Disease-specific uses 

In addition to the whole body effects of ashwagan- 
da, the plant is used for many other specific conditions. 
Different parts are used for different conditions. Ashwa- 
ganda is one of the most frequently used remedies in 
India. It is taken internally for: 

• anemia 

• arthritis 

• asthma 



• bronchitis 

• cancer 

• chronic fatigue syndrome 

• colds 

• coughs 

• depression 

• diarrhea 

• fluid retention 

• hemorrhoids 

• hypertension 

• hypoglycemia 

• leprosy 

• nausea 

• rheumatism 

• sexually transmitted diseases 

• stomach ulcers 

• systemic lupus erythematosus 

• tuberculosis 

• tumors 

Ashwaganda can also be made into a poultice for 
external use, as it is thought to have antibacterial and an- 
tifungal properties. It is used to prevent infection in skin 
wounds and to treat skin diseases, including psoriasis, 
ringworm, and scabies. 

Laboratory studies 

University and medical researchers have been study- 
ing ashwaganda since at least the early 1960s. Chemical 
analysis shows that ashwaganda contains compounds 
thought to have anti-tumor, anti-inflammatory, and anti- 
fungal properties. Other compounds have been isolated 
that are associated with ashwaganda’s sedative and anti- 
stress effects. 

The most rigorous laboratory tests have been done 
in test tubes and on rats, mice, and other small laboratory 
animals. There is no proof that ashwaganda affects hu- 
mans in the same way that it affects rodents. In animal 
studies, however, ashwaganda has been shown to have 
consistent anti-inflammatory, anti-fungal, anti-stress, and 
sedative effects. In one well-known study, extracts of 
ashwaganda root were shown to significantly increase 
the swimming endurance of rats in a test that is consid- 
ered a classic stress test. 

Experimenters have had mixed results in demon- 
strating anti-tumor and anti-cancer properties of ashwa- 
ganda. Many have found that extracts of ashwaganda 


root slow the growth of tumor cells in test-tube and 
small-animal experiments, but these results have not yet 
been reproduced in human subjects. Some researchers 
report that ashwaganda makes tumors more sensitive to 
chemotherapy and radiation therapy without increasing 
side effects caused by these therapies. 

Although there is little doubt that ashwaganda con- 
tains biologically active compounds that produce some 
of the healing effects in humans that have been found in 
test-tube and small-animal studies, few controlled stud- 
ies using people have been done. One drawback to arriv- 
ing at conclusive evidence in humans is that most people 
take ashwaganda as part of a multi-herb tonic, making it 
difficult for researchers to attribute specific actions to 
any one particular component of the formula. Scientific 
interest in ashwaganda is high, and laboratory studies 
continue to be performed. 


Ashwaganda is available in many forms, including 
powders, decoctions, essential oil, tinctures, and teas 
made from the root, root bark, and the leaves. Commer- 
cially ashwaganda is available as capsules. The usual cap- 
sule dosage is 300 mg of powdered root, taken once or 
twice a day. Tincture dosage is often 2-4 ml (0.5-1 tsp) 
daily. Ashwaganda tea can be made by boiling the roots 
for about 15 minutes. Three cups a day is recommended. 
The fruit is often chewed to assist in convalescence from 
prolonged illness. These are simply representative doses 
and uses, since Ayurvedic medicine is highly individual- 
ized. The dose recommended depends on both the body 
type of the person and the nature of his or her illness. 


Ashwaganda is not recommended for use by pregnant 
women. Thousands of years of use have shown that this 
plant is quite safe. On the other hand, laboratory tests indi- 
cate that rats given high levels of ashwaganda root extract 
develop kidney lesions. This effect has not been seen in 
humans, but using the herb in moderation may be prudent. 

Ashwaganda has a sedative effect on the central ner- 
vous system. It will enhance the effect of any other cen- 
tral nervous system sedatives (e.g., barbiturates or alco- 
hol) that are taken at the same time. People operating 
heavy equipment or working in situations that require a 
high level of alertness should keep this in mind when 
using ashwaganda. 

Side effects 

No undesirable side effects have been reported with 





Adaptogen — A substance that acts in nonspecific 
ways to improve the body's level of functioning 
and its adaptations to stress. 

Decoction — A liquid extract of a herb, made by 
simmering or boiling the herb in water, then 
straining out the plant parts. 

Poultice — A soft moist mass of cloth, usually con- 
taining herbs, applied warm or hot to relieve pain 
or speed healing in a part of the body. 

Psoriasis — A skin disease characterized by dry, 
scaling, whitish patches. 

Scabies — A contagious skin disease caused by a 
mite and characterized by small, raised, red, very 
itchy pinprick bumps on the skin. 

Tincture — An alcohol-based extract of a herb pre- 
pared by soaking plant parts in alcohol or a mix- 
ture of alcohol and water. 

Tonic — A medicine given to strengthen and invig- 
orate the body. Ashwaganda is frequently used as 
a tonic. 

Vegan — Food products made without any animal 
products such as meat, milk, or eggs. A vegan diet 
is a nutrition regimen that excludes all animal 


There are few, studies of how ashwaganda interacts 
with traditional Western medicines. It has been used for 
many years in combination with other Ayurvedic herbs 
without incident. Ayurvedic practitioners believe that 
when ashwaganda is combined with other herbs in reju- 
venation formulas, it enhances the effects of these other 



Chevallier, Andrew. Encyclopedia of Medicinal Plants. Lon- 
don: Dorling Kindersley, 1996. 

Peirce, Andrea. The American Pharmaceutical Association 
Practical Guide to Natural Medicines. New York: William 
Morrow and Company, 1999. 


American School of Ayurvedic Sciences. 2115 112th Avenue 
NE. Bellevue, WA 98004. (425) 453-8002. 

The Ayurvedic Institute. P. O. Box 23445. Albuquerque, NM 
87112. (505) 291-9698. 



“Withania somnifera aphrodisiaca Plants for the Future: 

Tish Davidson 



Asthma is a chronic inflammatory disease of the air- 
ways in the lungs. This inflammation periodically causes 
the airways to narrow, producing wheezing and breath- 
lessness sometimes to the point where the patient gasps 
for air. This obstruction of the air flow either stops spon- 
taneously or responds to a wide range of treatments. 
Continuing inflammation makes asthmatics hyper-re- 
sponsive to such stimuli as cold air, exercise, dust, pollu- 
tants in the air, and even stress or anxiety. 


Between 16 and 17 million Americans have asthma 
and the number has been rising since 1980. As many as 9 
million U.S. children under age 18 may have asthma. 
Blacks, Hispanics, American Indians, and Alaskan na- 
tives had higher rates of asthma-control problems than 
whites or Asians in the United States. 

The changes that take place in the lungs of asthmat- 
ics make their airways (the bronchi and the smaller bron- 
chioles) hyper-reactive to many different types of stimuli 
that do not affect healthy lungs. In an asthma attack, the 
muscle tissue in the walls of the bronchi go into spasm, 
and the cells that line the airways swell and secrete 
mucus into the air spaces. Both these actions cause the 
bronchi to narrow, a change that is called bronchocon- 
striction. As a result, an asthmatic person has to make a 
much greater effort to breathe. 

Cells in the bronchial walls, called mast cells, release 
certain substances that cause the bronchial muscle to con- 
tract and stimulate mucus formation. These substances, 
which include histamine and a group of chemicals called 
leukotrienes, also bring white blood cells into the area. 
Many patients with asthma are prone to react to substances 
such as pollen, dust, or animal dander; these are called al- 
lergens. Many people with asthma do not realize that aller- 
gens are triggering their attacks. On the other hand, asthma 
also affects many patients who are not allergic in this way. 

Asthma usually begins in childhood or adolescence, 
but it also may first appear in adult life. While the symp- 


toms may be similar, certain important aspects of asthma 
are different in children and adults. When asthma begins 
in childhood, it often does so in a child who is likely, for 
genetic reasons, to become sensitized to common aller- 
gens in the environment. Such a child is known as an 
atopic person. In 2004, scientists in Helsinki, Finland, 
identified two new genes that cause atopic asthma. The 
discovery might lead to earlier prediction of asthma in 
children and adults. When these children are exposed to 
dust, animal proteins, fungi, or other potential allergens, 
they produce a type of antibody that is intended to engulf 
and destroy the foreign materials. This has the effect of 
making the airway cells sensitive to particular materials. 
Further exposure can lead rapidly to an asthmatic re- 
sponse. This condition of atopy is present in at least one 
third and as many as one half of the general population. 
When an infant or young child wheezes during viral in- 
fections, the presence of allergy (in the child or a close 
relative) is a clue that asthma may well continue 
throughout childhood. 

Allergenic materials may also play a role when 
adults become asthmatic. Asthma can start at any age 
and in a wide variety of situations. Many adults who are 
not allergic have such conditions as sinusitis or nasal 
polyps, or they may be sensitive to aspirin and related 
drugs. Another major source of adult asthma is exposure 
at work to animal products, certain forms of plastic, 
wood dust, metals, and environmental pollution. 

Causes & symptoms 

In most cases, asthma is caused by inhaling an aller- 
gen that sets off the chain of biochemical and tissue 
changes leading to airway inflammation, bronchocon- 
striction, and wheezing. Because avoiding (or at least 
minimizing) exposure is the most effective way of treat- 
ing asthma, it is vital to identify which allergen or irri- 
tant is causing symptoms in a particular patient. Once 
asthma is present, symptoms can be set off or made 
worse if the patient also has rhinitis (inflammation of 
the lining of the nose) or sinusitis. When, for some rea- 
son, stomach acid passes back up the esophagus in a re- 
action called acid reflux, this condition also can make 
asthma worse. In addition, a viral infection of the respi- 
ratory tract can inflame an asthmatic reaction. Aspirin 
and drugs called beta-blockers, often used to treat high 
blood pressure, also can worsen the symptoms of asth- 
ma. But the most important inhaled allergens giving rise 
to attacks of asthma are: 

• animal dander 

• dust mites 

• fungi (molds) that grow indoors 




Air pollutants 
Animal dander 
Cockroach allergens 
Dust mites 
Indoor fungi (molds) 

Occupational allergens such as chemicals, fumes, 
particles of industrial materials 


• cockroach allergens 

• pollen 

• occupational exposure to chemicals, fumes, or particles 
of industrial materials 

• tobacco smoke 

• air pollutants 

In addition, there are three important factors that 
regularly produce attacks in certain asthmatic patients, 
and they may sometimes be the sole cause of symptoms. 
They are: 

• inhaling cold air (cold-induced asthma) 

• exercise-induced asthma (in certain children, asthma 
attacks are caused simply by exercising) 

• stress or a high level of anxiety 

Wheezing often is obvious, but mild asthmatic at- 
tacks may be confirmed when the physician listens to the 
patient’s chest with a stethoscope. Besides wheezing and 
being short of breath, the patient may cough or report a 
feeling of tightness in the chest. Children may have itch- 
ing on their back or neck at the start of an attack. Wheez- 
ing often is loudest when the patient exhales. Some asth- 
matics are free of symptoms most of the time but may 
occasionally be short of breath for a brief time. Others 
spend much of their days (and nights) coughing and 
wheezing until properly treated. Crying or even laughing 
may bring on an attack. Severe episodes often are seen 
when the patient gets a viral respiratory tract infection or 
is exposed to a heavy load of an allergen or irritant. 
Asthmatic attacks may last only a few minutes or can go 
on for hours or even days. Being short of breath may 
cause a patient to become very anxious, sit upright, lean 
forward, and use the muscles of the neck and chest wall 
to help breathe. The patient may be able to say only a 
few words at a time before stopping to take a breath. 
Confusion and a bluish tint to the skin are clues that the 




Source: “Occupational Asthma.” Occupational Safety and 
Health Administration, U.S. Department of Labor. (Stan- 
ley Publishing. Reproduced by permission.) 

oxygen supply is much too low and that emergency treat- 
ment is needed. In a severe attack, some of the air sacs in 
the lung may rupture so that air collects within the chest, 
which makes it even harder to breathe. The good news is 
that almost always, even patients with the most severe at- 
tacks will recover completely. 


Apart from listening to the patient’s chest, the exam- 
iner should look for maximum chest expansion while 
taking in air. Hunched shoulders and contracting neck 
muscles are other signs of narrowed airways. Nasal 
polyps or increased amounts of nasal secretions are often 
noted in asthmatic patients. Skin changes, like dermati- 
tis or eczema, are a clue that the patient has allergic 
problems. Inquiring about a family history of asthma or 
allergies can be a valuable indicator of asthma. A test 
called spirometry measures how rapidly air is exhaled 
and how much is retained in the lungs. Repeating the test 
after the patient inhales a drug that widens the air pas- 
sages (a bronchodilator) will show whether the narrow- 
ing of the airway is reversible, which is a very typical 
finding in asthma. Often patients use a related instru- 
ment, called a peak flow meter, to keep track of asthma 
severity when at home. 

Frequently, it is difficult to determine what is trig- 
gering asthma attacks. Allergy skin testing may be 
used, although an allergic skin response does not al- 
ways mean that the allergen being tested is causing the 
asthma. Also, the body’s immune system produces an 
antibody to fight off the allergen, and the amount of an- 
tibody can be measured by a blood test. The blood test 


will show how sensitive the patient is to a particular al- 
lergen. If the diagnosis is still in doubt, the patient can 
inhale a suspect allergen while using a spirometer to 
detect airway narrowing. Spirometry also can be re- 
peated after a bout of exercise if exercise-induced asth- 
ma is a possibility. A chest x-ray will help rule out 
other disorders. 


There are many alternative treatments available for 
asthma that have shown promising results. One strong 
argument for these treatments is that they try to avoid 
the drugs that allopathic treatment (combating disease 
with remedies to produce effects different from those 
produced by the disease) relies upon, which can be toxic 
and addictive. Mainstream journals have reported on the 
toxicity of asthma pharmaceuticals. A 1995 New 
Zealand study showed that before 1940, death from 
asthma was very low, but that the death rate promptly 
increased with the introduction of bronchodilators. The 
New England Journal of Medicine in 1992 reported that 
albuterol and other asthma drugs cause the lungs to de- 
teriorate when used regularly. A 1989 study in the An- 
nals of Internal Medicine showed that respiratory thera- 
pists, who are exposed to bronchodilator sprays, devel- 
op asthma five times more often than other healthcare 
professionals, which could imply that the drugs them- 
selves may induce asthma. Theophylline, another popu- 
lar drug, has been reported to cause personality changes 
in users. Steroids can also have negative effects on 
many systems in the body, particularly the hormonal 
system. Thus, natural and non-toxic methods for treat- 
ing asthma are the preferred first choice of alternative 
practitioners, while drugs are used to manage extreme 
cases and emergencies. 

Alternative medicine tends to view asthma as the 
body’s protective reaction to environmental agents and 
pollutants. As such, the treatment goal is often to restore 
balance to and strengthen the entire body and provide spe- 
cific support to the lungs, immune and hormonal systems. 
Asthma sufferers can help by keeping a diary of asthma 
attacks in order to determine environmental and emotional 
factors that may be contributing to their condition. 

Alternative treatments have minimal side effects, are 
generally inexpensive, and are convenient forms of self- 
treatment. They also can be used alongside allopathic 
treatments to improve their effectiveness and lessen their 
negative side effects. 

Dietary and nutritional therapies 

Some alternative practitioners recommend cutting 
down on or eliminating dairy products from the diet, as 


In normal bronchioles the airway 
is open and unobstructed. 

During an attack, the bronchioles of an 
asthma sufferer are constricted by bands 
of muscle around them. They may be 
further obstructed by increased mucus 
production and tissue inflammation. 

A comparison of normal bronchioles and those of an asthma sufferer. (Illustration by Hans & Cassidy. The Gale Group.) 

these increase mucus secretion in the lungs and are 
sources of food allergies. Other recommendations in- 
clude avoiding processed foods, refined starches and 
sugars, and foods with artificial additives and sulfites. 
Diets should be high in fresh fruits, vegetables, and 
whole grains, and low in salt. Asthma sufferers should 
experiment with their diets to determine if food allergies 
are playing a role in their asthma. Some studies have 
shown that a sustained vegan (zero animal foods) diet 
can be effective for asthma, as it does not contain the an- 
imal products that frequently cause food allergies and 
contain chemical additives. A vegan diet also eliminates 
a fatty acid called arachidonic acid, which is found in an- 
imal products and is believed to contribute to allergic re- 
actions. A 1985 Swedish study showed that 92% of pa- 
tients with asthma improved significantly after one year 
on a vegan diet. On the other hand, some people feel 


weaker on a vegan diet. In addition, many people are al- 
lergic to vegetables rather than to meat. 

Plenty of water should also be drunk by asthma suf- 
ferers, as water helps to keep the passages of the lungs 
moist. Onions and garlic contain quercetin, a flavonoid 
(a chemical compound/biological response modifier) 
that inhibits the release of histamine, and should be a 
part of an asthmatic’s diet. Quercetin also is available as 
a supplement, and should be taken with the digestive en- 
zyme bromelain to increase its absorption. 

As nutritional therapy, vitamins A, C and E have 
been touted as important. Also, the B complex vitamins, 
particularly B 6 and B 12 , may be helpful for asthma, as 
well as magnesium, selenium, and an omega-3 fatty 
acid supplement such as flaxseed oil. A good multivita- 
min supplement also is recommended. In 2004, a study 




of supplements at Cornell University showed that high 
levels of beta-carotene and vitamin C along with seleni- 
um lowered risk of asthma. However, the same study 
found that vitamin E had no effect. 

Herbal remedies 

Chinese medicine has traditionally used ma huang, 
or ephedra, for asthma attacks. It contains ephedrine, 
which is a bronchodilator used in many drugs. However, 
the U.S. Food and Drug Administration (FDA) issued a 
ban on the sale of ephedra that took effect in April 2004 
because it was shown to raise blood pressure and stress 
the circulatory system, resulting in heart attacks and 
strokes for some users. Ginkgo has been shown to reduce 
the frequency of asthma attacks, and licorice is used in 
Chinese medicine as a natural decongestant and expecto- 
rant. There are many formulas used in traditional Chi- 
nese medicine to prevent or ease asthma attacks, de- 
pending on the specific Chinese diagnosis given by the 
practitioner. For example, ma huang is used to treat so- 
called “wind-cold” respiratory ailments. 

Other herbs used for asthma include lobelia, also 
called Indian tobacco; nettle, which contains a natural 
antihistamine; thyme; elecampane mullein: feverfew; 
passionflower: saw palmetto: and Asian ginseng. Coffee 
and tea have been shown to reduce the severity of asthma 
attacks because caffeine works as a bronchodilator. Tea 
also contains minute amounts of theophylline, a major 
drug used for asthma. Ayurvedic (traditional East Indian) 
medicine recommends the herb Tylophora asthmatica. 

Mind/body approaches 

Mind/body medicine has demonstrated that psy- 
chological factors play a complex role in asthma. Emo- 
tional stress can trigger asthma attacks. Mind/body tech- 
niques strive to reduce stress and help asthma sufferers 
manage the psychological component of their condition. 
A 1992 study by Dr. Erik Peper at the Institute for Holis- 
tic Healing Studies in San Francisco used biofeedback, 
a treatment method that uses monitors to reveal physio- 
logical information to patients, to teach relaxation and 
deep breathing methods to 21 asthma patients. Eighty 
percent of them subsequently reported fewer attacks and 
emergency room visits. A 1993 study by Kaiser Perma- 
nente in Northern California worked with 323 adults 
with moderate to severe asthma. Half the patients got 
standard care while the other half participated in support 
groups. The support group patients had cut their asthma- 
related doctor visits in half after two years. Some other 
mind/body techniques used for asthma include relax- 
ation methods, meditation, hypnotherapy,, mental 
imaging, psychotherapy, and visualization. 


Yoga and breathing methods 

Studies have shown that yoga significantly helps 
asthma sufferers, with exercises specifically designed to 
expand the lungs, promote deep breathing, and reduce 
stress. Pranayama is the yogic science of breathing, 
which includes hundreds of deep breathing techniques. 
These breathing exercises should be done daily as part of 
any treatment program for asthma, as they are a very ef- 
fective and inexpensive measure. 

Controlled exercise 

Many people believe that those with asthma should 
not exercise. This is particularly true among parents of 
children with asthma. In a 2004 study, researchers re- 
ported that 20% of children with asthma do not get 
enough exercise. Many parents believe it is dangerous 
for their children with asthma to exercise, but physical 
activity benefits all children, including those with asth- 
ma. Parents should work with the child’s healthcare 
provider and any coach or organized sport leader to care- 
fully monitor his or her activities. 


Acupuncture can be an effective treatment for asth- 
ma. It is used in traditional Chinese medicine along with 
dietary changes. Acupressure can also be used as a self- 
treatment for asthma attacks and prevention. The Lung 1 
points, used to stimulate breathing, can be easily found 
on the chest. These are sensitive, often knotted spots on 
the muscles that run horizontally about an inch below the 
collarbone, and about two inches from the center of the 
chest. The points can be pressed in a circular manner 
with the thumbs, while the head is allowed to hang for- 
ward and the patient takes slow, deep breaths. Reflexolo- 
gy also uses particular acupressure points on the hands 
and feet that are believed to stimulate the lungs. 

Other treatments 

Aromatherapists recommend eucalyptus, lavender, 
rosemary, and chamomile as fragrances that promote 
free breathing. In Japan, a common treatment for asthma 
is administering cold baths. This form of hydrotherapy 
has been demonstrated to open constricted air passages. 
Massage therapies such as Rolfing can help asthma suf- 
ferers as well, as they strive to open and increase circula- 
tion in the chest area. Homeopathy uses the remedies 
Arsenicum album, Kali carbonicum, Natrum sul- 
phuricum, and Aconite. 

Allopathic treatment 

Allopaths recommend that asthma patients should 
be periodically examined and have their lung functions 


measured by spirometry. The goals are to prevent trou- 
blesome symptoms, to maintain lung function as close to 
normal as possible, and to allow patients to pursue their 
normal activities, including those requiring exertion. The 
best drug therapy is that which controls asthmatic symp- 
toms while causing few or no side effects. 


The chief methylxanthine drug is theophylline. It 
may exert some anti-inflammatory effect and is especial- 
ly helpful in controlling nighttime symptoms of asthma. 
When, for some reason, a patient cannot use an inhaler 
to maintain long-term control, sustained-release theo- 
phylline is a good alternative. The blood levels of the 
drug must be measured periodically, as too high a dose 
can cause an abnormal heart rhythm or convulsions. 

Beta-receptor agonists (drugs that trigger cell re- 
sponse) are bronchodilators. They are the drugs of 
choice for relieving sudden attacks of asthma and for 
preventing attacks from being triggered by exercise. 
Some agonists, such as albuterol, act mainly in lung cells 
and have little effect on the heart and other organs. These 
drugs generally start acting within minutes, but their ef- 
fects last only four to six hours. They may be taken by 
mouth, inhaled, or injected. In 2004, a new lower con- 
centration of albuterol was approved by the FDA for 
children ages two to 12. 

Steroids are drugs that resemble natural body hor- 
mones. They block inflammation and are effective in re- 
lieving symptoms of asthma. When steroids are taken by 
inhalation for a long period, asthma attacks become less 
frequent as the airways become less sensitive to aller- 
gens. Steroids are the strongest medicine for asthma, and 
can control even severe cases over the long term and 
maintain good lung function. However, steroids can 
cause numerous side effects, including bleeding from the 
stomach, loss of calcium from bones, cataracts in the 
eye, and a diabetes-like state. Patients using steroids for 
lengthy periods may also have problems with wound 
healing, may gain weight, and may suffer mental prob- 
lems. In children, growth may be slowed. Besides being 
inhaled, steroids may be taken by mouth or injected, to 
rapidly control severe asthma. 

Leukotriene modifiers are among a newer type of 
drug that can be used in place of steroids, for older chil- 
dren or adults who have a mild degree of persistent asth- 
ma. They work by counteracting leukotrienes, which are 
substances released by white blood cells in the lung that 
cause the air passages to constrict and promote mucus 
secretion. Other drugs include cromolyn and ne- 
docromil, which are anti-inflammatory drugs that often 
are used as initial treatments to prevent long-term asth- 


matic attacks in children. Montelukast sodium (Singu- 
lair) is a drug taken daily that is used to help prevent 
asthma attacks rather than to treat an acute attack. In 
2004, the FDA approved an oral granule formula of Sin- 
gulair for young children. 

If a patient's asthma is caused by an allergen that 
cannot be avoided and it has been difficult to control 
symptoms by drugs, immunotherapy may be worth try- 
ing. In a typical course of immunotherapy, increasing 
amounts of the allergen are injected over a period of 
three to five years, so that the body can build up an effec- 
tive immune response. There is a risk that this treatment 
may itself cause the airways to become narrowed and 
bring on an asthmatic attack. Not all experts are enthusi- 
astic about immunotherapy, although some studies have 
shown that it reduces asthmatic symptoms caused by ex- 
posure to dust mites, ragweed pollen, and cats. 

Managing asthmatic attacks 

A severe asthma attack should be treated as quickly 
as possible. It is most important for a patient suffering an 
acute attack to be given extra oxygen. Rarely, it may be 
necessary to use a mechanical ventilator to help the pa- 
tient breathe. A beta-receptor agonist is inhaled repeated- 
ly or continuously. If the patient does not respond 
promptly and completely, a steroid is given. A course of 
steroid therapy, given after the attack is over, will make a 
recurrence less likely. 

Long-term allopathic treatment for asthma is based 
on inhaling a beta-receptor agonist using a special in- 
haler that meters the dose. Patients must be instructed in 
proper use of an inhaler to be sure that it will deliver the 
right amount of drug. Once asthma has been controlled 
for several weeks or months, it is worth trying to cut 
down on drug treatment, but this tapering must be done 
gradually. The last drug added should be the first to be 
reduced. Patients should be seen every one to six 
months, depending on the frequency of attacks. Starting 
treatment at home, rather than in a hospital, makes for 
minimal delay and helps the patient to gain a sense of 
control over the disease. All patients should be taught 
how to monitor their symptoms so that they will know 
when an attack is starting. Those with moderate or se- 
vere asthma should know how to use a flow meter. They 
also should have a written plan to follow if symptoms 
suddenly become worse, including how to adjust their 
medication and when to seek medical help. If more in- 
tense treatment is necessary, it should be continued for 
several days. When deciding whether a patient should be 
hospitalized, the physician must take into account the pa- 
tient's past history of acute attacks, severity of symp- 
toms, current medication, and the availability of good 
support at home. 




Expected results 

Most patients with asthma respond well when the 
best treatment or combination of treatments is found and 
they are able to lead relatively normal lives. Patients who 
take responsibility for their condition and experiment 
with various treatments have good chances of keeping 
symptoms minimal. Having urgent measures to control 
asthma attacks and ongoing treatment to prevent attacks 
are important as well. More than one half of affected 
children stop having attacks by the time they reach 21 
years of age. Many others have less frequent and less se- 
vere attacks as they grow older. A small minority of pa- 
tients will have progressively more trouble breathing. 
Because they run a risk of going into respiratory failure, 
they must receive intensive treatment. 


Prevention is extremely important in the treatment of 
asthma, which includes eliminating all possible allergens 
from the environment and diet. Homes and work areas 
should be as dust and pollutant-free as possible. Areas 
can be tested for allergens and high-quality air filters can 
be installed to clean the air. If the patient is sensitive to a 
family pet, removing the animal or at least keeping it out 
of the bedroom (with the bedroom door closed) is ad- 
vised. Keeping the pet away from carpets and upholstered 
furniture, and removing all feathers also helps. To reduce 
exposure to dust mites, it is recommended to remove 
wall-to-wall carpeting, keep the humidity low, and use 
special pillows and mattress covers. Cutting down on 
stuffed toys, and washing them each week in hot water, is 
advised for children with asthma. If cockroach allergen is 
causing asthma attacks, controlling the roaches (using 
traps or boric acid rather than chemicals) can help. 

It is important to not to leave food or garbage exposed. 
Keeping indoor air clean by vacuuming carpets once or 
twice a week (with the asthmatic person absent), and 
avoiding use of humidifiers is advised. Those with asthma 
should avoid exposure to tobacco smoke and should not 
exercise outside when air pollution levels are high. When 
asthma is related to exposure at work, taking all precau- 
tions, including wearing a mask and, if necessary, arrang- 
ing to work in a safer area, is recommended. For chronic 
sufferers who live in heavily polluted areas, moving to less 
polluted regions may even be a viable alternative. 



Bock, Steven J. Natural Relief for Your Child’ s Asthma. New 

York: HarperPerennial, 1999. 

Cutler, Ellen W. Winning the War against Asthma and Aller- 
gies. New York: Delmar, 1998. 



Allergen — A foreign substance that causes the air- 
ways to narrow and produces symptoms of asth- 
ma when inhaled. 

Atopy — A state that makes persons more likely to 
develop allergic reactions of any type, including 
the inflammation and airway narrowing typical of 

Bronchodilator — A type of medication that acts to 
open up bronchial tubes that have constricted in 
an asthmatic attack. 

Hypersensitivity — A condition in which very 
small amounts of allergen can cause the airways 
to constrict and bring on an asthmatic attack. 
Leukotrienes — Substances that are produced by 
white blood cells in response to antigens and con- 
tribute to inflammatory and asthmatic reactions. 

Pranayama — Breathing techniques taught in yoga. 
Quercetin — A flavonoid (chemical compound/bi- 
ological response modifier) found in onions and 
garlic that may be a useful dietary supplement for 
asthma patients. 

Vegan diet — A vegetarian diet that excludes meat 
and dairy products. 


Allergy and Asthma Magazine. 702 Marshall St., Suite 61 1. 
Redwood City, CA 94063. (605) 780-0546. 

“Allergy Season Can Mean Trouble." Respiratory Therapeutics 
Week (April 19, 2004):9. 

“Asthma Antioxidants.” Better Nutrition (May 2004):26-27. 

“Children with Asthma Inactive Due to Parental Health Beliefs, 
Disease Severity.” Obesity, Fitness & Wellness Week (May 
1, 2004):8. 

“Identification of New Asthma Genes Demonstrates Model for 
Improved Patient Care.” Drug Week (April 30, 2004):27. 

McNamara, Daniel. “Singulair.” Family Practice News (Febru- 
ary 1,2004): 108-109. 

“Nine Million U.S. Children Diagnosed With Asthma, New 
Report Finds." Medical Letter on the CDC & FDA (April 
25, 2004): 11. 

“Patent Granted for Pediatric Asthma Medication.” Health & 
Medicine Week (April 12, 2004):552. 

Ressel, Genevieve. “FDA Issues Regulation Prohibiting Sale of 
Dietary Supplements Containing Ephedra.” American 
Family Physician (March 15, 2004): 1343. 

“U.S. Asthma Rates on the Rise." Medical Letter on the CDC 
<6 FDA (March 28, 2004): 1 1. 



Asthma and Allergy Foundation of America. 1125 15th St. 
NW, Suite 502. Washington, DC 20005. 800-7 ASTHMA. 

Center for Complementary and Alternative Medicine Research 
in Asthma, Allergy, and Immunology. University of Cali- 
fornia at Davis. 3150B Meyer Hall. Davis, CA 95616. 
(916) 752-6575. <>. 

Douglas Dupler 
Teresa G. Odle 



Astigmatism is a problem of visual distortion caused 
by a misshapen cornea. The cornea acts as a focusing 
lens for the eye. If the cornea does not have the proper 
shape, the eye is unable to properly focus an image. 
Most people have a certain degree of astigmatism. Cor- 
rective measures are necessary only in cases where the 
distortion is severe. 


Light rays entering a normal eye come to a point of 
focus on the retina through a transparent, dome-shaped 
layer called the cornea. In astigmatism there is unequal 
curvature of the cornea, and the light rays come to focus at 
more than one point on the retina. This causes the person 
to see a blurred or doubled image. Astigmatism is usually 
present at birth and may increase during childhood as the 
eye tissue develops. Usually the degree of astigmatism re- 
mains fairly constant throughout adulthood. 

Causes & symptoms 

It is unknown why some people develop a mis- 
shapen cornea. It is possible that astigmatism is an inher- 
ited trait. Factors such as stress, continual reading in dim 
lighting, or excessive close-up work may also contribute 
to the development of astigmatism. It is sometimes 
caused by pressure from chalazion, a condition that 
causes the eyelid to swell; from scars on the cornea; or 
from keratoconus, a condition that involves swelling of 
the cornea. The main symptom of astigmatism is blurred 
or distorted vision. There may also be a history of 
headaches, eye strain, fatigue, and double vision. 


The standard eye examination with a refraction 
test, given by an optometrist or opthalmologist, is 


Horizontal line out of focus 

Astigmatism corrected by lens 

Astigmatism can be treated by the use of cylindrical lenses. 
The lenses are shaped to counteract the shape of the sec- 
tions of the cornea that are causing the difficulty. (Illustra- 
tion by Electronic Illustrators Group.) 

used to determine the presence of astigmatism. An in- 
strument called a keratometer is used to measure the 
cornea and calculate the shape of the required correc- 
tive lens. 


The Bates method or other type of visual training 
may be helpful in improving vision and reducing symp- 
toms. The homeopathic remedies Ruta graveolens (from 
common rue) and Apis mellifica (from the honey bee) 
can be used to relieve eyestrain, one of the main symp- 
toms and possible contributors to astigmatism. 

Acupuncture treatment or Traditional Chinese 
Medicine may help, as the liver system is connected to 
eye functions. Certain treatments can strengthen and 
correct the skewing of the Liver qi. ( Qi is the flow of 
energy in the body. It is sometimes associated with cer- 
tain organs.) 





Chalazion — A condition in which clogging of the 
Meibomiam gland causes a cyst inside the eyelid. 

Keratoconus — A progressive condition in which 
the cornea takes on a cone shape, causing major 
changes in the eye's refractive power. 

Refraction — The turning or bending of light waves 
as the light passes from one medium or layer to 
another. In the eye it means the ability of the eye 
to bend light so that an image is focused onto the 

Refractive surgery — Eye surgery to correct a de- 
fect in the eye's ability to focus accurately on an 

Retina — The substance of the eye, made of nerve 
tissue. It receives and transmits images to the 

Allopathic treatment 

Astigmatism can be most simply treated with either 
eyeglasses or contact lenses. The lenses are made so as 
to counteract the shape of the sections of cornea that are 
causing difficulty. Contact lenses that are used to correct 
astigmatism are called toric lenses. Hard contact lenses 
may be better for correcting astigmatism than soft con- 
tact lenses. In the case of keratoconus, a corneal trans- 
plant is performed if the astigmatism cannot be corrected 
with hard contact lenses. 

Refractive surgery can be performed to correct the 
curvature of the cornea. In radial keratotomy (RK) for 
astigmatism, cuts are made into the cornea with a dia- 
mond blade instrument. In photorefractive keratectomy 
(PRK), a laser is used to improve the shape of the cornea 
by removing micro-thin slices. Laser assisted in situ ker- 
atomileusis (LASIK) is the most recently developed type 
of refractive surgery. A flap of the cornea is cut with a 
laser and then the corneal tissue underneath is shaved to 
improve the shape. 

Doctors continue to improve LASIK techniques. In 
2002, a cross-cylinder method was developed in refrac- 
tive surgery to help treat mixed astigmatism, one of the 
most difficult types to treat. Refractive surgery requires 
a high level of expertise. Anyone considering it should 
make sure that the surgeon has a lot of experience in 
the procedure. There should also be an in-depth discus- 
sion of the possible side effects and risks of the proce- 
dure. For instance, patients with flatter corneas seem to 
come out of surgery with more light distortion than 


those with curved corneas. Pupil size also may affect 
surgery outcome. 

Expected results 

Effects of astigmatism can generally be greatly im- 
proved with eyeglasses or contact lenses. Refractive 
surgery may diminish the need for lenses or make them 
unecessary altogether. The major risks of surgery include 
chronic visual problems, injury to the eye tissue, infec- 
tion, and over- or under-correction, which would still 
leave some astigmatism. Complications may require the 
use of medication or further surgery. 



Lininger, Skye, ed. The Natural Pharmacy. Rocklin, Calif.: 
Prima Health, 1998. 

Newell, Frank W. Ophthalmology, Principles and Concepts. 
8th ed. St. Louis: Mosby, 1996. 


“Clues to LASIK Vision Problems (Risk of ‘Starbursts’).” Pre- 
vention (June 2002): 161. 

Meszaros, Liz. “Cross-Cylinder Technique Offers Many Bene- 
fits. Little Trauma: Method to Correct Mixed Astigmatism 
Minimizes Tissue Removal, not Ideal for High-Correction 
Cases.” Ophthalmology Times (May 15, 2002): 41. 


“Refractive Surgery.” The Merck Manual Online. (December 

Patience Paradox 
Teresa G. Odle 



Aston-Patterning is an integrated system of move- 
ment education, bodywork, ergonomic adjustments, and 
fitness training that recognizes the relationship between 
the body and mind for well being. It helps people who 
seek a remedy from acute or chronic pain by teaching 
them to improve postural and movement patterns. 


Aston-Patterning is a process originated by Judith 
Aston in 1977. After graduating from college with an 
advanced degree in dance, Aston began working with 


athletes, dancers, and actors in movement education pro- 
grams in California. In 1968 she suffered injuries from 
two automobile accidents. In seeking relief from pain, 
she met Dr. Ida Rolf, the innovator of Rolfing. When 
Aston recovered from her injuries, Rolf asked her to de- 
velop a movement education program that would com- 
plement the gains achieved with rolfing. She worked 
with Rolf in creating this program from 1971 to 1977. 

By 1977 Aston and Rolf’s interests and views of 
bodywork had diverged. Aston left Rolf and established 
her own techniques, which she called Aston-Patterning. 
She has also developed a special program for older peo- 
ple called the Aston-Patterning Fitness Program for Se- 
niors. Today Aston-Patterning is a registered trademark 
of the Aston Paradigm Corporation of which Judith 
Aston is the director. 


Aston-Patterning assists people in finding more effi- 
cient and less stressful ways of performing the simple 
movements of everyday life to dissipate tension in the 
body. This is done through massage, alteration of the en- 
vironment, and fitness training. 


Seeking to solve movement problems, Aston-Pat- 
terning helps make the most of their own unique body 
types rather than trying to force them to conform to an 
ideal. Unlike Rolfing, it doesn’t strive for linear symme- 
try. Rather it works with asymmetry in the human body 
to develop patterns of alignment and movement that feel 
right to the individual. Aston also introduced the idea of 
working in a three-dimensional spinal pattern. 

Aston-Patterning sessions have four general compo- 
nents. They are: 

• A personal history that helps the practitioner assess the 
client’s needs. 

• Pre-testing, in which the practitioner and the client explore 
patterns of movement and potential for improvement. 

• Movement education and bodywork, including mas- 
sage, myofacial release, and arthrokinetics, to help re- 
lease tension and make new movement patterns easier. 

• Post-testing, when pre-testing movements are repeated, 
allowing the client to feel the changes that have taken 
place and integrate them into daily life. 

Aston-Patterning requires more participation from 
the client than many bodywork techniques. The massage 
aspect of Aston-Patterning is designed around a three-di- 
mensional, non-compressive touch that releases patterns 
of tension in the body. It is gentler than Rolfing. Myoki- 



Judith Aston was born in Long Beach, California. 
She graduated from University of California at Los An- 
geles with a B.A. and a M.F.A. in dance. Her interest in 
movement arose from working as a dancer. In 1963 
Aston established her first movement education pro- 
gram for dancers, actors, and athletes at Long Beach 
City College. 

Five years later, while recovering from injuries sus- 
tained during two consecutive automobile accidents, 
Aston met Ida Rolf, the developer of rolfing. Aston 
began working for Rolf, teaching a movement educa- 
tion program called Rolf-Aston Structural Patterning that 
emphasized using the body with minimum effort and 
maximum precision. 

In time, Rolf and Aston's views on movement di- 
verged, and the partnership was dissolved in 1977. 
Aston formed her own company called the Aston Para- 
digm Corporation in Lake Tahoe, California. This com- 
pany provides training and certification for Aston practi- 
tioners. She also began exploring how environmental 
conditions affect body movement, foreshadowing the 
ergonomic movement in the workplace that developed 
in the 1990s. Over time, Aston has expanded her move- 
ment work to include a fitness program for older adults. 
Today, Judith Aston serves as director of Aston Paradigm 

Tish Davidson 

netics uses touch to release tension in the face and neck. 
Arthrokinetics addresses tension at bones and joints. 
This massage is accompanied by education about the es- 
tablishment of new movement patterns. 

In addition to Aston-Patterning sessions, clients are 
also helped to examine their environment for factors, such 
as seating or sleeping arrangements, that may limit their 
body function and introduce tension. Finally, they may 
choose to participate in the Aston fitness training program 
that includes loosening techniques based on self-massage, 
toning, stretching, and cardiovascular fitness. 


Since clients typically work with an Aston-Pattern- 
ing practitioner for extended periods of time, it is impor- 
tant that they feel comfortable with their specific practi- 
tioner. Certified Aston practitioners recommend that 
prospective clients make a get-acquainted visit before 
enrolling in a course of treatment. 





Aston-Patterning can be quite demanding. People 
with any of the following diseases or disorders should 
consult a physician before undertaking a course of 
Aston-Patterning : 

• Heart conditions. 

• Diabetes. Because diabetes affects blood circulation, 
diabetics taking Aston-Patterning should ask the practi- 
tioner to avoid massage of the legs and feet. 

• Carpal tunnel syndrome. Aston-Patterning may worsen 
the pain associated with this disorder. 

• Respiratory disorders, including asthma and emphysema. 

• Osteoporosis. The deep tissue massage in Aston-Pat- 
terning may cause hairline fractures in brittle bones. 

• Bleeding disorders and other disorders requiring treat- 
ment with anticoagulant or corticosteroid medications. 
Drugs in these categories can make the tissues fragile. 

• Disorders requiring medications that affect the sense of 

• Post-traumatic stress syndromes. People suffering from 
acute stress disorder, post-traumatic stress disorder, 
or other emotional disorders related to abuse should 
consult a psychotherapist as well as a physician before 
undertaking any form of bodywork. The physical con- 
tact involved in Aston-Patterning may cause flashbacks 
or bring up emotional and psychological issues. 

The Aston-Patterning program can, however, be mod- 
ified to meet the needs of older adults, those in poor 
health, or persons with special rehabilitation requirements. 

Side effects 

Most clients of Aston-Patterning report a diminution 
of tension, improved ease of movement, and an enhanced 
feeling of well-being. Some clients, however, do report 
side effects, the most common being pain and exhaustion. 
To minimize side effects, clients should give the practi- 
tioner as much feedback as possible during sessions. 

Research & general acceptance 

Aston-Patterning is an outgrowth of Rolfing that has 
been shown to be of benefit in a limited number of con- 
trolled studies. Little controlled research has been done on 
either the benefits or limitations of Aston-Patterning; as of 
early 2003, no reports have been published in any peer-re- 
viewed medical, alternative medical, or bodywork journals. 
Its claims have been neither proven nor disproved, al- 
though anecdotally many clients report relief from pain 
and tension as well as improved body movement. Aston- 



Bodywork — Any healing technique involving 
hands-on massage or manipulation of the body. 

Ergonomics — A branch of applied science that co- 
ordinates the physical design and arrangement of 
furniture, machines, and other features of a living 
or working environment with the needs and re- 
quirements of the individuals in that environment. 
Rolfing — Developed by Dr. Ida Rolf (1896-1979), 
rolfing is a systematic approach to relieving stress 
patterns and dysfunctions in the body's structure 
through the manipulation of the highly pliant myofa- 
cial (connective) tissue. It assists the body in reorga- 
nizing its major segments into vertical alignment. 

Patterning is a member of the International Alliance of 
Healthcare Educators (IAHE), and Judith Aston is a fre- 
quent speaker at IAHE conferences. In addition, Aston’s 
postural assessment workbook is used by practitioners in 
other fields of bodywork and physical therapy. 

Training & certification 

The Aston Training Center in Incline Village, Nevada, 
offers courses and certification and promotes a code of 
ethics among its practitioners. Certification must renewed 
annually. As of early 2003 there are certified Aston-Pat- 
terning practitioners in fifteen states, with the largest con- 
centrations in California, Colorado, and Washington. 



Aston, Judith. Aston Postural Assessment Handbook: Skills for 
Observing and Evaluating Body Patterns. San Diego, CA: 
Academic Press, Inc., 1998. 

Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part 
I: Sound Mind, Sound Body. New York: Simon & Schus- 
ter, 2002. 


Aston Training Center. P. O. Box 3568, Incline Village, NV 
89450. (775) 831-8228. <>. 
International Alliance of Healthcare Educators (IAHE). 11211 Pros- 
perity Farms Road, D-325, Palm Beach Gardens, FL 34410. 
(561) 622-4334 or (800) 311-9204. <>. 


Rast, Mechthild. Book Review: Aston Postural Assessment Work- 
book. Neuro-Developmental Treatment Association Network 
January-February 2000. <>. 

Tish Davidson 
Rebecca J. Frey, PhD 




Astragalus, also called milk vetch root, is the root of 
the Astragalus membranaceus plant, which is a member 
of the pea family. This perennial grows to a height of 2-A 
ft. (5-10 cm). It has white or yellow flowers and leaves 
with 10-18 pairs of leaflets. The large yellow taproots of 
four- to seven-year-old plants are used for medicinal pur- 
poses. Although there are many varieties in the Astra- 
galus family. Astragalus membranaceus is the sole medi- 
cinal type. The plant is found only in the grasslands and 
mountains of central and western Asia, principally in 
China, Taiwan, and Korea. Astragalus is a good source of 
selenium, an antioxidant and immune system stimulant. 

General use 

Astragalus is called Huang Qi in traditional Chi- 
nese medicine (TCM) and is considered to be an im- 
portant tonic herb. It is used to strengthen what is 
called the wei qi, or the defensive energy of the body 
against disease. TCM identifies astragalus as being 
helpful in conditions involving the Spleen, the Lungs, 
and the Triple Burner. It is a warming tonic, and it im- 
proves the functioning of the qi (the flow of energy in 
the body), the Spleen, the Blood, and the fluids of the 
body. Astragalus is recommended for Spleen deficien- 
cy symptoms, such as diarrhea, fatigue, sweating, 
and lack of appetite. It is used as a tonic for the Lungs 
and is good for shortness of breath, asthma, and 
chronic lung problems. Astragalus is prescribed for 
arthritis, diarrhea, and nervous symptoms. It is often 
given to people who are in a state of generally poor or 
weakened health. 

Astragalus is classified as an adaptogen, an herb that 
increases the body’s endurance and resistance to a wide 
array of physical, chemical, and biological stressors. 
Adaptogens help normalize the functioning of various 
body systems by affecting the action of hormones. Adap- 
togens are usually beneficial in treating chronic condi- 
tions. They have been found to enhance the immune re- 
sponse, reduce inflammation, stabilize blood sugar, and 
support the hormone systems, particularly the adrenal 
and pituitary glands. Adaptogens should be used for an 
extended period of time — at least six weeks. 

Astragalus helps the body function at its best 
level. It helps the body deal with stress and enhances 
overall immune function. It has been shown to stimu- 
late production and activation of the white blood cells, 
which fight infection. It is highly recommended for 
preventing and alleviating colds and flu. Astragalus 


can be used to cure chronic weaknesses of the lungs. 
Because it improves blood circulation and heart func- 
tion, astragalus is useful in treating heart disease. It 
has also been found to prevent or reduce blood clot- 
ting. Astragalus can be taken as a tonic for the kidneys. 
It has a diuretic (urine-producing) effect and so it 
flushes out the urinary system. It is thus very effective 
in treating kidney infections, proteinuria (too much 
protein in the urine), chronic prostate problems, and 
chronic urinary tract problems. 

Astragalus is helpful to those taking chemotherapy 
and radiation treatments. It reduces toxic side effects and 
enhances therapeutic effects. Cancer patients who take 
astragalus during or after cancer treatments tend to re- 
cover more quickly from the ill effects of the treatment, 
and they generally have better survival rates. This ap- 
pears to be connected with the strengthening of the im- 
mune system. Astragalus also stimulates the adrenal 
glands, whose functions are suppressed in cancer. The 
herb improves poor appetite, diarrhea, weakness, wast- 
ing, and night sweats. This makes it helpful for cancer 
patients as well as AIDS sufferers and those with other 
debilitating diseases. 

Astragalus is recommended as a tonic for the el- 
derly. It protects cells from the aging process and 
may diminish other negative effects of aging. For ex- 
ample, it strengthens digestion, stimulates the ap- 
petite, and helps improve mental functioning. Astra- 
galus shows promise in the treatment of Alzheimer’s 
disease. By itself or in combinations, it may be useful 
in treating viral infections, hypoglycemia, diabetes 
mellitus, chronic ulcers, insomnia, 
hyperthyroidism, chronic fatigue syndrome, open 
wounds, liver problems, sexual dysfunction, fertility 
problems, and autoimmune diseases. 


Astragalus is available as a capsule, a tablet, a tinc- 
ture, as a part of an herbal combination, as a prepared 
tea, and as a sweet dried root that can be eaten or made 
into tea. Traditionally, several slices of the root are often 
added to soups and stews. A strong tea can be made by 
boiling three ounces of astragalus root in three cups of 
water and letting the mixture steep for at least five min- 
utes. Two or three cups of the unheated tea can be taken 
over the course of a day. In tincture form, 30-60 drops of 
astragalus can be taken four times per day. Candied roots 
can be purchased ready-made or prepared in the home. 
Preparation involves combining four parts of the dried 
root with one part honey in water, then simmering until 
the herb is dried and brownish. In TCM, astragalus oint- 
ments are used to heal wounds, particularly those that 
are slow to heal. 






Adrenal glands — Glands atop the kidneys that 
produce hormones. 

Blood— In TCM, it is the fluid that transports phys- 
ical and emotional nourishment. 

Heat condition — A disease whose symptoms in- 
clude fever, rashes, redness, dehydration, and in- 

Lungs — In TCM, the parts of the body associated 
with breathing, such as the lungs and the skin. It 
also regulates the movement of water and qi 
through the body channels. 

Qi — In the TCM system, the underlying force that 
controls the body's movement, resistance to dis- 
ease, use of nourishment, tissue integrity, and tem- 
perature. It circulates through channels, or path- 
ways, called meridians. 

Spleen — In TCM, the system of organs that in- 
cludes the pancreas, large muscles, the lips, the 
eyelids, the lymph system, and the spleen. It also 
includes the functions that extract nourishment 
and convert it into qi and Blood. 

Triple Burner — The pathways and relationships 
between the Spleen, the Lungs and the Kidney. 


Since astragalus is a warming herb, its use should be 
avoided in heat conditions, such as fevers or agitated 
states. Astragalus membranaceus is the only species of 
its family to have a medicinal use; other species may be 
toxic. Therefore, local Western varieties should not be 
used. Use only the root portion of the plant; other parts 
of the plant may be poisonous. 

Side effects 

Sometimes individuals experience a slight stomach 
upset or allergic reaction to astragalus. However, it is 
generally a very safe herb, even at high doses. 


Astragalus increases the effectiveness of other herbs 
when used in combinations. It is often used with Siberian 
ginseng, Eleutherococcus senticosus; Echinacea spp.; 
dong quai, Angelica sinensis; and Lingusticum wallichi. 
Astragalus may interfere with the actions of diuretics, phe- 
nobarbital, beta-blockers, and anticoagulants (substances 
that prevent blood clotting). Users of these medications 
should consult a healthcare provider before using the herb. 



Graedon, Joe, and Teresa Graedon. The People's Pharmacy 
Guide to Home and Herbal Remedies. New York: St. Mar- 
tin’s Press, 1999. 

Green, James. The Male Herbal: Health Care for Men and 
Boys. Freedom, Calif.: Crossing Press, 1991. 

Hart, Carol, and Magnolia Goh. Traditional Chinese Medicine: 
The A-Z Guide to Natural Healing from the Orient. New 
York: Dell. 1997. 


“Astragalus.” Go-Symmetry, < 

“Astragalus.” The Herbalist, < 

“Astragalus." <http://www.herbsherbals. 

“Astragalus." Pro Health International, <http://www.planet.eon. 
net/~wiggles/astra 1 galus.htm.> 

Patience Paradox 



Atherosclerosis is the build up of plaque on the inside 
of blood vessels. Atherosclerosis is often called arterioscle- 
rosis, which is a general term for hardening of the arteries. 


Atherosclerosis, a progressive condition responsible 
for most heart disease, is a type of hardening of the ar- 
teries. It can be caused by normal aging processes, by 
high blood pressure, and by some diseases, such as dia- 
betes. Atherosclerosis can begin in the late teens, but it 
usually takes decades for the signs and symptoms of the 
disease to be apparent. Some people experience rapidly 
progressing atherosclerosis in their 30s or later. 

An artery is made up of several layers: an inner lin- 
ing called the endothelium, an elastic membrane that al- 
lows the artery to expand and contract, a layer of smooth 
muscle, and a layer of connective tissue. Atherosclerosis 
affects the inner lining of an artery. It is characterized by 
plaque deposits that block the flow of blood. Plaque is 
made of fatty substances, cholesterol, waste products 
from the cells, calcium, iron, and fibrin, a material that 
helps clot blood. 

As plaque builds up in and around the cells of the 
artery walls, they accumulate calcium. The innermost 


layer thickens, the artery’s diameter is reduced, and 
blood flow and oxygen delivery are decreased. Plaque 
can rupture or crack open, causing the sudden formation 
of a blood clot, called a thrombosis. As a result of throm- 
bosis and/or the buildup of plaque, atherosclerosis can 
cause a heart attack if it completely blocks the blood 
flow in the coronary arteries. It can cause a stroke if it 
completely blocks the carotid arteries of the brain. Ath- 
erosclerosis can also occur in the arteries of the neck, 
kidneys, thighs, and arms, and may lead to kidney fail- 
ure, gangrene, and even death. 

Causes & symptoms 

It is thought that atherosclerosis is caused by the 
body’s response to damage to the artery wall from cho- 
lesterol, high blood pressure, and cigarette smoking. A 
person who has all three of these risk factors is eight 
times more likely to develop atherosclerosis than is a 
person who has none. Physical inactivity, damage by ox- 
idants, diabetes, and obesity are also risk factors for ath- 
erosclerosis. High levels of the amino acid homocysteine 
and abnormal levels of fats called lipoproteins also raise 
the risk. Other risk factors include: 

• High triglycerides. Most fat in food and in the body 
takes the form of triglycerides. Blood triglyceride levels 
above 400 mg/dL have been linked to atherosclerosis. 

• Physical inactivity. Lack of exercise increases the risk 
of atherosclerosis. 

• Diabetes mellitus. The risk of developing atherosclero- 
sis is seriously increased for diabetics and can be low- 
ered by keeping diabetes under control. Many diabetics 
die from heart attacks caused by atherosclerosis. 

• Obesity. Excess weight increases the strain on the heart 
and increases the risk of developing atherosclerosis, 
even if no other risk factors are present. 

• Heredity. People whose parents have coronary artery 
disease, atherosclerosis, or stroke at an early age are at 
increased risk. 

• Sex. Before age 60, men are more likely to have heart 
attacks than women. 

• Age. Risk is higher in men who are 45 years of age and 
older and women who are 55 years of age and older. 

The symptoms of atherosclerosis differ depending 
upon the location. They may involve: 

• In the coronary (heart) arteries: chest pain, heart at- 
tack, and sudden death. 

• In the carotid arteries of the brain: sudden dizziness, 
weakness, loss of speech, and blindness. 


• In the femoral arteries of the legs: cramping and fa- 
tigue in the calves of the legs when walking. 

• In the renal arteries of the kidneys: high blood pressure 
resistant to treatment. 


Physicians may be able to make a diagnosis of ath- 
erosclerosis during a physical exam by means of a listen- 
ing to the activity of the arteries and the heart with a 
stethoscope and probing them with the hands. More de- 
finitive tests are usually called for, however. These in- 
clude an electrocardiogram, which shows the heart’s ac- 
tivity; exercise electrocardiography, more familiarly 
known as a stress test, conducted while the patient exer- 
cises on a treadmill or a stationary bike; echocardiogra- 
phy, a type of ultrasound using sound waves to create an 
image of the heart’s chambers and valves; and ultra- 
sonography to assess arteries of the neck and thighs. 

Radionuclide angiography and thallium scanning 
use radioactive material injected into the bloodstream. 
These tests enable physicians to see the blood flow 
through the coronary arteries and the heart chambers and 
to record pictures of the heart. Coronary angiography is 
the most accurate diagnostic method for artheroscerosis, 
and it is also the only invasive procedure. A cardiologist 
inserts a catheter equipped with a viewing device into a 
blood vessel in the leg or arm and guides it into the heart. 
A contrast dye makes the heart visible to x rays. Motion 
pictures are taken of the dye flowing though the arteries, 
and plaques and blockages are well defined. 


The most common treatments focus on dietary and 
lifestyle changes to reduce cholesterol and other prob- 
lems that contribute to atherosclerosis. Dietary modifica- 
tions usually incorporate eating foods that are low in sat- 
urated fats, cholesterol, sugar, and animal proteins. Foods 
high in fiber, such as fresh fruits and vegetables, and 
whole grains, are encouraged. By consuming fruits and 
vegetables, the person also consumes helpful dietary an- 
tioxidants, such as carotenoids found in vegetable pig- 
ments, and bioflavenoids in fruit pigments. Liberal use of 
onions and garlic is recommended, as well as eating fish, 
especially cold-water fish, such as salmon. Smoking, al- 
cohol, and coffee are to be avoided; and exercise is 
strongly recommended. There are several well-known 
programs, such as those created by Nathan and Robert 
Pritikin and Dean Ornish, which are very helpful in set- 
ting up and maintaining dietary and lifestyle programs. 

Herbal remedies for atherosclerosis include garlic 
( Allium sativum), ginger (Zingiber officinale), haw- 




thorn (Crataegus oxycantha), (Ginkgo biloba), and 
Siberian ginseng root (Eleutherococcus senticosus). 
Gugulipids, or myrrh (Commiphora molmol ) is highly 
regarded for its ability to lower cholesterol and triglyc- 
eride levels. Other herbs with this ability include alfalfa 
(Medicago sativum), turmeric (Curcuma longa), (Panax 
ginseng ), and fenugreek (Trigonella foenum-graecum). 
Atherosclerosis is a complex condition. Therefore, a 
knowledgeable practitioner of herbal healing should be 
consulted for recommendations on the right combination 
of herbs and dosages. 

Chelation therapy involves injecting a drug called 
EDTA and drug taken orally called DMSA, together 
with nutrients into the bloodstream. It is thought to work 
by either binding to the calcium in plaque and transport- 
ing it for excretion, or by acting as an antioxidant, or by 
both methods. It has shown some success, but it remains 
a controversial method. 

Several disciplines can offer helpful long-term 
treatment strategies for those with atherosclerosis. A 
knowledgeable practitioner should be consulted. 
Ayurvedic medicine practitioners combine diet, herbal 
remedies, relaxation, and exercises. A homeopath will 
prescribe a treatment regimen based on a complete as- 
sessment. A traditional Chinese medicine practitioner 
may prescribe a combination of herbs such as siler 
(Ledebouriellla divaricata), Platycodon grandiflorum. 
Polygonum multiflorum, and Bupleurum chinense. 
Acupuncture and massage may be recommended, par- 
ticularly for the accompanying circulatory problems. A 
homeopath will prescribe remedies based on an in-depth 
interview and evaluation. 

Stress is known to worsen blood pressure and ather- 
osclerosis, and hasten the progression of the disease. 
Therapeutic relaxation techniques are, therefore, helpful 
adjuncts to treatment. Recommended approaches include 
yoga, meditation, guided imagery, biofeedback, and 
counseling. In fact, a 2002 study showed that transcen- 
dental meditation, when combined with diet, exercise 
and antioxidant food supplements, contributed to nearly 
a 33% reduced long-term risk for heart attack and stroke 
in some patients. 

Allopathic treatment 

Allopathic treatment includes medications, balloon 
angioplasty, and coronary artery bypass surgery. Most of 
the drugs prescribed for atherosclerosis seek to improve 
conditions that contribute to the disease, such as high 
cholesterol, blood clots, or high blood pressure. 

Angioplasty and bypass surgery are invasive proce- 
dures that improve blood flow in the coronary arteries. 
Coronary angioplasty is performed by a cardiologist. It 



Cardiac catheterization — A treatment using a nar- 
row tube to clear out a blocked blood vessel. 

Cholesterol — A fat-like substance that is made by 
the human body and eaten in animal products. 
Cholesterol is used to form cell membranes and 
process hormones and vitamin D. High choles- 
terol levels contribute to the development of ath- 

Homocysteine — An amino acid involved with 
protein use in the body. High levels have been im- 
plicated in the development of atherosclerosis. 

Triglyceride — A fat that comes from food or is 
made from other energy sources in the body. Ele- 
vated triglyceride levels contribute to the develop- 
ment of atherosclerosis. 

is a nonsurgical procedure in which a catheter tipped 
with a balloon is threaded from a blood vessel in the 
thigh into the blocked artery. When the balloon is inflat- 
ed, it compresses the plaque and enlarges the blood ves- 
sel to open the blocked artery. In one-third of patients, 
the artery narrows again within six months. The proce- 
dure may have to be repeated and a wire mesh stent may 
be placed in the artery to help keep it open. In bypass 
surgery, a detour is created with grafted or synthetic 
blood vessels. The blood can then go around the block- 
age. Other procedures may be used, including catheteri- 
zation and laser treatments. 

Expected results 

Atherosclerosis can be successfully treated, but not 
cured. Studies have shown that atherosclerosis can be 
delayed, stopped, and even reversed by aggressively low- 
ering cholesterol and changing the diet. 


A healthy lifestyle — eating right, regular exercise, 
maintaining a healthy weight, not smoking, and control- 
ling hypertension — can reduce the risk of developing ath- 
erosclerosis, help keep the disease from progressing, and 
sometimes cause it to regress. A 2002 study presented 
promising news about the impact of simple exercise on 
modifying the elasticity of one’s arteries. A small group 
of healthy but sedentary postmenopausal women began 
walking at a moderate pace for 40 to 45 minutes a day 
five times a week. By the end of 12 weeks, 48% of the 
women had restored elasticity to their carotid arteries. 




American Heart Association and American Cancer Society, ed. 
Living Well, Staying Well. New York and Toronto: American 
Heart Association and American Cancer Society, 1996. 

The Editors of Time-Life Books. The Medical Advisor: The 
Complete Guide to Alternative & Conventional Treatments. 
Virginia: Time-Life Books, 1997. 

Shealy, C. Norman. The Complete Family Guide to Alternative 
Medicine. New York: Barnes & Noble Books, 1996. 


“Research Briefs: Meditation Reduces Atherosclerosis.” GP 
(May 13, 2002): 4. 

"Walking Aids Older Women’s Arterial Elasticity, Helping 
Heart.” Women s Health Weekly (May 23, 2002): 3. 


American Heart Association, National Center. 7272 Greenville 
Avenue, Dallas, TX 75231M596, <> 

National Heart, Lung, and Blood Institute. RO. Box 30105, 
Bethesda, MD 20824-0105. < 

Patience Paradox 
Teresa G. Odle 

Athlete's foot 


Athlete’s foot is a common fungus infection in 
which the skin of the feet, especially on the sole and 
toes, becomes itchy and sore, cracking and peeling away. 
Athlete’s foot, also known as tinea pedis, can be difficult 
to clear up completely. 

Athlete’s foot received its common name because 
the infection is often found among athletes. This is be- 
cause the fungi flourish best in the around swimming 
pools, showers, and locker rooms. 


Athlete’s foot is very common, so common that 
most people will have at least one episode with this fun- 
gal infection at least once in their lives. It is found more 
often in adult males. In fact, symptoms that appears to be 
athlete’s foot in young children are probably caused by 
some other skin condition. 

Causes & symptoms 

Athlete’s foot is caused by a fungal infection that espe- 
cially affects the skin between the toes. The fungi that cause 


Athlete’s foot fungus on toes of patient. (Custom Medical 
Stock Photo. Reproduced by permission.) 

athlete’s foot include Trichophyton ruhrum, T. mentagro- 
phytes, and Epidermophyton floccosum. These fungi live 
exclusively on dead body tissue, such as hair, the outer layer 
of skin, and the nails. The fungus grows best in moist, 
damp, dark places with poor ventilation. The problem is 
rare in children and those who customarily go barefoot. 

Most people carry fungus on their skin. However, it 
will only flourish to the point of causing athlete’s foot if 
conditions are right. The fungi multiply on the skin when it 
is irritated, weakened, or continuously moist. Sweaty feet, 
tight shoes, synthetic socks that do not absorb moisture 
well, a warm climate, and not drying the feet well after 
swimming or bathing, all contribute to the overgrowth of 
the fungus. Symptoms include itchy, sore skin on the toes, 
with scaling, inflammation, and blisters. Blisters that 
break, exposing raw patches of tissue, can cause pain and 
swelling. The infected feet also may have an unpleasant 
smell. As the infection spreads, itching and burning may 
worsen. In severe cases, the skin cracks and seeps fluid. 
Sometimes a secondary bacterial infection is also present. 

If it is not treated, athlete’s foot can spread to the 
soles of the feet and toenails. Stubborn toenail infections, 
called tinea unguium, may appear at the same time, with 
crumbling, scaling, and thickened nails, and nail loss. The 
infection can spread further if patients scratch and then 
touch themselves elsewhere (especially in the groin or 
under the arms). It is also possible to spread the infection 
to other parts of the body via contaminated bed sheets, 
towels, or clothing. Athlete’s foot is more severe and more 
common in people taking antibiotics, corticosteroids, birth 
control pills, drugs to suppress immune function, and in 
people with obesity, AIDS, and diabetes mellitus. 


A dermatologist can diagnose the condition by 
physical examination and by examining a preparation of 


Athlete's foot 

Athlete's foot 

skin scrapings under a microscope. Not all foot rashes 
are athlete’s foot, which is why a physician should diag- 
nose the condition before any remedies are used. In 
order to properly diagnose the infection, the physician 
may do a fungal culture. Using nonprescription products 
on a rash that is not athlete's foot could worsen the rash, 
therefore, proper diagnosis is important. 


The infected foot should be kept well ventilated. A 
foot bath containing cinnamon has been shown to slow 
down the growth of certain molds and fungi, and is said 
to be very effective in clearing up athlete’s foot. Eight to 
ten broken cinnamon sticks are boiled in four cups of 
water, simmered for five minutes, and then steeped for 
45 minutes. The mixture can be then placed in a basin 
and used daily to soak the feet. 

Herbal remedies used externally to treat athlete’s 
foot include goldenseal ( Hydrastis canadensis ), tea tree 
oil ( Melaleuca spp.), myrrh ( Commiphora molmol ), gar- 
lic (Allium sativa), oregano oil (though its smell is quite 
pungent), and calendula. The affected area should be 
swabbed with an herbal mixture twice daily or the feet 
should be soaked in a herbal footbath. Pau d’arco, also 
called taheebo or lapacho, can be used for athlete’s foot 
as well. The tea bags can be soaked in water for about 10 
minutes and then placed on the affected areas, or by mak- 
ing a tincture and directly rubbing the tea onto the toes. 

Aromatherapy may be helpful. Several drops of the 
essential oils of tea tree, peppermint (Mentha piperita), or 
chamomile (Matricaria recutita ), can be added to the bath 
water. Chamomile may be applied directly to the toes. 

Allopathic treatment 

Simple cases of athlete’s foot usually respond to an- 
tifungal creams or sprays, such as tolnaftate (Aftate or 
Tinactin), clotrimazole, miconazole nitrate (Micatin 
products), or Whitfield’s tincture made of salicylic acid 
and benzoic acid. Athlete’s foot may be resistant to topi- 
cal medication and should not be ignored. If the infec- 
tion is resistant, the doctor may prescribe an oral antifun- 
gal drug such as ketoconozole or griseofulvin. Untreated 
athlete’s foot may lead to a secondary bacterial infection 
in the skin cracks. 

Expected results 

Athlete’s foot usually responds well to treatment, but 
it is important to complete the recommmended treatment, 
even if the skin appears to be free of fungus; otherwise, 
the infection could return. Tinea unguium may accompany 
athlete’s foot. It is typically very hard to treat effectively. 



Corticosteroids — Synthetic hormones which con- 
trol nutritional processes in the body as well as 
the function of several organ systems. 


A healthy diet should be maintained. Foods with a 
high sugar content should be avoided, including undilut- 
ed fruit juice, honey, and maple syrup. 

Good personal hygiene and a few simple precau- 
tions can help prevent athlete’s foot. These include: 

• The feet should be washed daily; care should be taken 
to avoid contact with other parts of the body. 

• The feet should be kept dry, especially between toes. 

• Tight shoes and shoes made of synthetic material 
should not be worn. 

• The feet need to be kept well ventilated, especially in 
the summer; bare feet and sandals are recommended. 

• Absorbent polypropylene or white cotton socks are rec- 
ommended; they should be and changed often. 

• Bathing shoes should be worn in public bathing or 
showering areas. 

• A good quality foot powder should be used to keep the 
feet dry. 

• If anyone in the family has athlete’s foot, towels, 
floors, and shower stalls should be washed with hot 
water and disinfectant after use. 



Donahue, Peggy Jo. Relief from Chronic Skin Problems. New 
York: Dell Publishing, 1992. 

Orkin, Milton, Howard Maibach, and Mark Dahl. Dermatol- 
ogy. Connecticut: McGraw-Hill Professional Publishing, 

Stoffman, Phyllis. The Family Guide to Preventing and Treat- 
ing 100 Infectious Illnesses. New York: John Wiley and 
Sons, 1995. 

Thompson, June, et al. Mosby’s Clinical Nursing. St. Louis: 
Mosby, 1998. 


American Podiatric Medical Association. 9312 Old George- 
town Rd., Bethesda, MD 20814. 

Patience Paradox 


Atkins diet 


The Atkins diet is a high-protein, high-fat, very low- 
carbohydrate regimen. It emphasizes meat, cheese, and 
eggs, while discouraging foods such as bread, pasta, 
fruit, and sugar. It is a form of ketogenic diet. 


Robert C. Atkins, a cardiologist and internist, devel- 
oped the diet in the early 1970s. It first came to public at- 
tention in 1972 with the publication of Dr. Atkins' Diet 
Revolution. It quickly became a bestseller but unlike 
most other fad diets, has remained popular. At last count, 
it had sold more than 15 million copies worldwide. Since 
then, Atkins authored a number of other books on his 
diet theme before his accidental death in 2003. 


The primary benefit of the diet is rapid and substan- 
tial weight loss. By restricting carbohydrate intake, the 
body will bum more fat stored in the body. Since there 
are no limits on the amount of calories or quantities of 
foods allowed on the diet, there is little hunger between 
meals. According to Atkins, the diet can alleviate symp- 
toms of conditions such as fatigue, irritability, 
headaches, depression, and some types of joint and 
muscle pain. 


The regimen is a low-carbohydrate, or ketogenic 
diet, characterized by initial rapid weight loss, usually 
due to water loss. Drastically reducing the amount of 
carbohydrate intake causes liver and muscle glycogen 
loss, which has a strong but temporary diuretic effect. 
Long-term weight loss is said to occur because with a 
low amount of carbohydrate intake, the body burns 
stored fat for energy. 

The four-step diet starts with a two-week induction 
program designed to rebalance an individual’s metabo- 
lism. Unlimited amounts of fat and protein are allowed 
but carbohydrate intake is restricted to 15-20 grams per 
day. Foods allowed include butter, oil, meat, poultry, 
fish, eggs, cheese, and cream. The daily amount of car- 
bohydrates allowed equals about three cups of salad veg- 
etables, such as lettuce, cucumbers, and celery. 

The second stage is for ongoing weight loss. It allows 
15-40 grams of carbohydrates a day. When the individual 
is about 10 pounds from their desired weight, they begin 
the pre-maintenance phase. This gradually adds one to 


three servings a week of high carbohydrate foods, such as 
a piece of fruit or slice of whole-wheat bread. When the 
desired weight is reached, the maintenance stage begins. It 
allows 40-60 grams of carbohydrates per day. 


No advance preparation is needed to go on the diet. 
However, as with most diets, it is generally considered ap- 
propriate to consult with a physician and to have a physi- 
cal evaluation before starting such a nutritional regimen. 
The evaluation should include blood tests to determine 
levels of cholesterol, triglycerides, glucose, insulin, and 
uric acid. A glucose tolerance test also is recommended. 


Adherence to the Atkins diet can result in vitamin 
and mineral deficiencies. In his books, Atkins recom- 
mends a wide range of nutritional supplements, includ- 
ing a multi-vitamin. Among his recommendations, 
Atkins suggests the following daily dosages: 300-600 
micrograms (meg) of chromium picolinate, 100-400 
milligrams (mg) of pantetheine, 200 meg of selenium, 
and 450-675 meg of biotin. 

The diet is not recommended for lacto-ovo vegetari- 
ans, since it cannot be done as successfully without pro- 
tein derived from animal products. Also, vegans cannot 
follow this diet, since a vegan diet is too high in carbohy- 
drates, according to Atkins. Instead, he recommends 
vegetarians with a serious weight problem give up vege- 
tarianism, or at least include fish in their diet. In 2003, a 
physicians group warned that high-protein diets may 
cause permanent kidney loss in anyone with reduced 
kidney function. They also can increase people’s risk of 
colon cancer and osteoporosis. 

Side effects 

According to Atkins, the diet causes no adverse side 
effects. Many health care professionals disagree. In a 
fact sheet for the Healthcare Reality Check Web site 
(, Ellen Coleman, a registered dieti- 
cian and author, said the diet may have serious side ef- 
fects for some people. She said complications associated 
with the diet include ketosis, dehydration, electrolyte 
loss, calcium depletion, weakness, nausea, and kidney 
problems. “It is certainly riskier for overweight individu- 
als with medical problems such as heart disease, hyper- 
tension, kidney disease, and diabetes than it is for over- 
weight people with no health problems,” she said. 

People with diabetes taking insulin are at risk of be- 
coming hypoglycemic if they do not eat appropriate car- 
bohydrates. Also, persons who exercise regularly may 


Atkins diet 

Atkins diet 

DR. ROBERT C. ATKINS 1930-2003 

(APAA/ide World Photos. Reproduced by permission.) 

Dr. Robert C. Atkins graduated from the University of 
Michigan in 1951 and received his medical degree from 
Cornell University Medical School in 1955 with a special- 
ty in cardiology. As an internist and cardiologist he devel- 
oped the Atkins diet in the early 1 970s. The diet is a keto- 

genic diet — a high protein, high fat, and very low carbohy- 
drate regimen resulting in ketosis. It emphasizes meat, 
cheese, and eggs, while discouraging foods such as bread, 
pasta, fruit, and sugar. It first came to public attention in 
1 972 with the publication of Dr. Atkins' Diet Revolution. 
The book quickly became a bestseller but unlike most 
other fad diet books, this one has remained popular. At last 
count, it had been reprinted 28 times and sold more than 
10 million copies worldwide. Since then, Atkins has au- 
thored a number of other books on his diet theme, includ- 
ing Dr. Atkins' New Diet Revolution (1992), Dr. Atkins' 
Quick and Easy New Diet Cookbook (1 997), and The Vita- 
Nutrient Solution: Nature's Answer to Drugs (1 998). 

During his life, Atkins saw about 60,000 patients in 
his more than 30 years of practice. He also appeared on 
numerous radio and television talk shows, had his own 
syndicated radio program, Your Health Choices, and au- 
thored the monthly newsletter Dr. Atkins' Health Revela- 
tions. Atkins received the World Organization of Alterna- 
tive Medicine's Recognition of Achievement Award and 
was named the National Health Federation's Man of the 
Year. He was the director of the Atkins Center for Com- 
plementary Medicine which he founded in the early 
1980s until his death in 2003. The center is located at 
152 E. 55th St., New York, NY 10022. 

Ken R. Wells 

experience low energy levels and muscle fatigue from 
low carbohydrate intake. 

Research & general acceptance 

Opinion from the general medical community re- 
mains mixed on the Atkins diet, but is generally unfavor- 
able. There have been no significant long-term scientific 
studies on the diet. A number of leading medical and 
health organizations, including the American Medical As- 
sociation, American Dietetic Association (ADA), and the 
American Heart Association oppose it. It is drastically 
different than the dietary intakes recommended by the 
U.S. Department of Agriculture and the National Insti- 
tutes of Health. Much of the opposition is because the 
diet lacks some vitamins and nutrients, and because it is 
high in fat. In a hearing before the U.S. Congress on Feb- 
ruary 24, 2000, an ADA representative called the Atkins 
diet “hazardous” and said it lacked scientific credibility. 

Just a month after Dr. Atkins’ death, two studies of- 
fering scientific support of the diet’s claims emerged. 
The research found that people lost weight without rais- 


ing their cholesterol. However, one of the studies 
showed that at the end of one year, dieters regained 
much of the weight. 

Training & certification 

There is no formal training or certification required. 



Atkins, Dr. Robert C. Dr. Atkins' Age-Defying Diet Revolution. 

New York: St. Martin’s Press. 1999. 

Atkins, Dr. Robert C. Dr. Atkins' Diet Revolution: The High 
Calorie Way to Stay Thin Forever. New York: Bantam 
Books. 1989. 

Atkins, Dr. Robert C. Dr. Atkins’ New Diet Revolution. New 
York City: Avon Books. 1992. 

Atkins, Dr. Robert C. Dr. Atkins' Health Revolution: How 
Complementary Medicine Can Extend Your Life. New 
York: Bantam Books. 1990. 

Atkins, Dr. Robert C. Dr. Atkins’ Vita-Nutrient Solution: Na- 
ture’s Answer to Drugs. New York: Simon & Schuster. 



Biotin — A B complex vitamin, found naturally in 
yeast, liver, and egg yolks. 

Carbohydrates — Neutral compounds of carbon, 
hydrogen, and oxygen found in sugar, starches, 
and cellulose. 

Hypertension — Abnormally high arterial blood 
pressure, which if left untreated can lead to heart 
disease and stroke. 

Ketogenic diet — A diet that supplies an abnormal- 
ly high amount of fat, and small amounts of car- 
bohydrates and protein. 

Ketosis — An abnormal increase in ketones in the 
body, usually found in people with uncontrolled 
diabetes mellitus. 

Pantetheine — A growth factor substance essential 
in humans, and a constituent of coenzyme A. 
Triglycerides — A blood fat lipid that increases the 
risk for heart disease. 


Alger, Alexandra. “Meat’s Neat.” Forbes (August 11, 1997): 

“Atkins Diet Vindicated But Long-term Success Questionable.” 
Obesity, Fitness and Wellness Week (June 14, 2003): 25. 

Carroll, Joanne. “The Ketogenic Diet: A Practical Guide for 
Caregivers.” Journal of the American Dietetic Association 
(March 1998): 316-321. 

Cray, Dan, et al. “The Low-Carb Diet Craze.” Time (November 
1, 1999): 72-79. 

“Doctor Group Describes Dangers of Atkins Diet.” Obesity, 
Fitness and Wellness Week (August 9, 2003): 33. 

Gotthardt, Melissa Meyers. “The New Low-Carb Diet Craze.” 
Cosmopolitan (February 2000): 148. 

Hammock, Delia. “Dr. Atkins’ New Diet Revolution.” Good 
Housekeeping (June 1997): 127. 

Howe, Maggy. “Excess Pounds.” Country Living (November 
1995): 60-61. 

Merrell, Woodson. "How I Became a Low-Carb Believer.” 
Time (November 1, 1999): 80. 

Turner, Richard. “The Trendy Diet That Sizzles.” Newsweek 
September 6, 1999): 60. 


Atkins Center for Complementary Medicine. 152 E. 55th St.. 
New York. NY 10022. 212-758-2110. http://www.atkins 

Ken R. Wells 
Teresa G. Odle 


Atopic dermatitis see Eczema 



Atractylodes is the dried or steam-dried rhizome 
(rootstalk) of Atractylodes macrocephala or A. ovata , 
perennial north Asian herbs in the Compositae family. It 
grows in mountain valleys, especially in China’s Zhe- 
jiang province. It may also be cultivated. In autumn, it 
presents magenta corolla blooms. 

In Mandarin, atractylodes is called Bai Zhu, Bai Shu, 
Yu Zhu, and Dong Zhu. The Cantonese term is Paak Sat , 
and the Japanese call it Byakujutsu. Common names in- 
clude large-headed atractylodes, white atractylodes, and 
white shu. Its pharmaceutical name, used to distinguish it 
as a medicine, is Rhizoma Atractylodis, and it is one of 
more than 500 plants recognized as official drugs in tradi- 
tional Chinese medicine. Related species, A. lancea and 
A. chinensis , both called black or gray atractylodes, are 
also used medicinally for similar but distinct purposes. 

General use 

Practitioners of Chinese medicine believe that 
atractylodes affects the Spleen and Stomach meridians, 
or energy pathways in the body. Its medicinal properties 
are considered warm, mildly bitter, and sweet. 

Atractylodes is thought to dry dampness, strengthen 
the Spleen or digestion, and promote diuresis, the forma- 
tion and excretion of urine. It is used for diarrhea, gen- 
eralized aching, mental fatigue, dizziness, lack of ap- 
petite, vomiting, edema (accumulation of fluids), and 
spontaneous sweating. It is also used to prevent miscar- 
riage and to treat restless fetal movement. Other uses in- 
clude restoring deficient digestion associated with poor 
absorption, malnutrition, anorexia, metabolic acidosis, 
hypogylcemia, and rheumatism. It has also been used to 
treat tumors of the cervix, uterus, breast, and stomach. 

According to traditional Chinese medicine, both white 
and black atractylodes may be used for digestive and urinary 
problems. Black atractylodes is more drying than white. 
White atractylodes has the additional benefit of being a 
“Spleen Qi tonic,” meaning that it rebuilds metabolic func- 
tion by increasing nutrition, increasing energy, and regulat- 
ing fluids. White atractylodes is also thought to have restora- 
tive, normalizing effects on the digestive system and Liver. 

Research on atractylodes has generally been conducted 
in China and has focused on pharmacological investigation 
and animal experiments. In-vitro and animal studies show it 



Attention-deficit hyperactivity disorder 


Cold — In Chinese pathology, the term defines a 
condition that has insufficient warmth, either ob- 
jective (hypothermia) or subjective (feeling cold). 

Decoction — A strong tea brewed for twenty to 
thirty minutes. 

Heat — In Chinese pathology, the term defines a 
condition that has excessive heat, either objective 
(fever, infection) or subjective (feeling hot). 

Meridians — Energetic pathways inside the body 
through which qi flows; also called channels. 

Tincture — A solution of medicinal substance in alco- 
hol, usually more or less diluted. Herb tinctures are 
made by infusing the alcohol with plant material. 

Qi — A Chinese medical term denoting active 
physiological energy. 

has significant diuretic, sedative, and hypoglycemic (lower- 
ing of blood glucose) effects. Animal studies pinpoint the 
essential oil as responsible for sedative effects. It also pro- 
motes digestion and quells nausea and diarrhea. 

Major chemical constituents include atractylone, 
atractylol, butenolide B, acetoxyatractylon, hydroxya- 
tractylon, and vitamin A. 


Atractylodes is not generally available in American 
health food stores, but it can be found at most Chinese 
pharmacies and Asian groceries. Good quality atracty- 
lodes is large, firm, solid, aromatic, and has a yellowish 
cross section. 

The standard dose is 3-10 g as a decoction (strong tea) 
or 1—4 ml of tincture. Doses of dried material are 3-12 g. 

Atractylodes is commonly prescribed in conjunction 
with moisture-removing drugs and digestants. Practition- 
ers of Chinese medicine commonly also combine 
atractylodes with other Chinese herbs. The following are 
the major herbs with which it is combined and the symp- 
toms for which the combinations are prescribed. 

• Radix codonopsis ( Codonopsis pilosula, Dang Shen) 
and rhizoma zingiberis ( Zingiber officinalis, Gan 
Jiang , dried ginger root) for abdominal pain, disten- 
tion, vomiting, and diarrhea. 

• Fructus Immaturus Citri Aurantii ( Citrus aurantium, 
Zhi Shi, unripened bitter orange) for reduced appetite 
with abdominal distention and fullness due to Spleen 
deficiency with qi stagnation. 


•Gray or black atractylodes (Atractylodes japonica, 
Cang Zhu ) for damp-cold painful obstruction or vagi- 
nal discharge. 

• Sclerotium Poriae Cocos ( Poria cocos; Fu Ling ; tucka- 
hoe, poria, or Indian bread) and Ramulus Cinnamomi 
Cassiae ( Cinnamomum cassia, Gui Zhi, cinnamon 
twig) for congested fluids with distention of the chest 
and edema due to Spleen deficiency. 

• Astragalus (Astragalus memhranaceus, Huang Qi) and 
Fructus Tritici ( Triticum aestivum, Fu Xiao Mai, name 
wheat grain) for unrelenting spontaneous sweating. 

• Ramulus Perillae (Perilla frutescens, Su Geng ) and 
Pericarpium Citri Reticulatae (Citrus reticulata, Chen 
Pi, aged tangerine rind) for restless fetus disorder with 
qi stagnation giving rise to distention and fullness in 
the chest and abdomen. 


According to tradition, atractylodes is contraindicat- 
ed in the presence of deficient heat conditions. 

Side effects 

None noted. 


No interactions with pharmaceutical drugs have 

been noted. 



Bensky, Dan, and Andrew Gamble. Chinese Herbal Medicine: 
Materia Meclica. Rev. ed. Seattle: Eastland Press, 1993. 

Fan, Warner J-W. A Manual of Chinese Herbal Medicine: Prin- 
ciples and Practice for Easy Reference. Boston: Shamb- 
hala, 1996. 

Holmes, Peter. Jade Remedies: A Chinese Herbal Reference for 
the West. Boulder, Colo.: Snow Lotus Press, 1996. 

Hsu, Hong-yen, et al. Oriental Materia Medica: A Concise 
Guide. Long Beach, Calif.: Oriental Healing Arts Insti- 
tute, 1986. 

Erika Lenz 

hyperactivity disorder 


Attention-deficit hyperactivity disorder (ADHD) is 
a developmental disorder characterized by distractibility, 


hyperactivity, impulsive behaviors, and the inability to 
remain focused on tasks or activities. 


ADHD, also known as hyperkinetic disorder (HKD) 
outside the United States, is estimated to affect 7% of 
children ages six to 11, or about 1.6 million children in 
the United States. It also affects about 4% of adults. The 
disorder affects boys more often than girls. Although dif- 
ficult to assess in infancy and toddlerhood, signs of 
ADHD may begin to appear as early as age two or three, 
but the symptom picture changes as adolescence ap- 
proaches. Many symptoms, particularly hyperactivity, 
diminish in early adulthood. However, impulsivity and 
inattention problems remain with up to 50% of ADHD 
individuals throughout their adult life. 

Children with ADHD have short attention spans and 
are easily bored and/or frustrated with tasks. Although 
they may be quite intelligent, their lack of focus fre- 
quently results in poor grades and difficulties in school. 
ADHD children act impulsively, taking action first and 
thinking later. They are constantly moving, running, 
climbing, squirming, and fidgeting, but often have trou- 
ble with gross and fine motor skills. As a result, they 
may be physically clumsy and awkward. Their clumsi- 
ness may extend to the social arena, where they are 
sometimes shunned due to their impulsive and intrusive 
behavior. Some critics argue that ADHD is a condition 
created and diagnosed in the Western world, particular to 
the environment of highly developed countries, since it is 
not diagnosed in other cultures. These critics of the 
ADHD diagnosis feel that medicating a child does not 
address the true underlying problem. They also note that 
there may not be a problem at all because children are 
naturally active and impulsive. 

Causes & symptoms 

The causes of ADHD are not known. However, it ap- 
pears that heredity plays a major role in the development 
of ADHD. Children with an ADHD parent or sibling are 
more likely to develop the disorder. Before birth, ADHD 
children may have been exposed to poor maternal nutri- 
tion, viral infections, or maternal substance abuse. In 
early childhood, exposure to lead or other toxins can 
cause ADHD-like symptoms. Traumatic brain injury or 
neurological disorders also may trigger ADHD symp- 
toms. Although the exact cause of ADHD is not known, 
an imbalance of certain neurotransmitters (the chemicals 
in the brain that send messages between nerve cells) is 
believed to be the mechanism behind ADHD symptoms. 

A widely publicized study conducted by Ben Fein- 
gold in the early 1970s suggested that allergies to certain 


foods and food additives caused the characteristic hyper- 
activity of ADHD children. Although some children may 
have adverse reactions to certain foods that can affect 
their behavior (for example, a rash might temporarily 
cause a child to be distracted from other tasks), carefully 
controlled follow-up studies have uncovered no link be- 
tween food allergies and ADHD. Another popularly held 
misconception about food and ADHD is that eating 
sugar causes hyperactive behavior. Again, studies have 
shown no link between sugar intake and ADHD. It is im- 
portant to note, however, that a nutritionally balanced 
diet is important for normal development in all children. 

People with ADHD suffer from a variety of symp- 
toms. These symptoms include such things as distrac- 
tion, not paying attention, inconsistency, forgetfulness of 
even simple tasks, fidgeting, verbal impulsivity, and so 
on. It is interesting to note that everyone suffers from 
these symptoms at times, but an individual with ADHD 
will have more of these symptoms more of the time. 

Some doctors indicated immature symmetric tonic 
neck reflex (STNR) as a possible cause of certain symp- 
toms. Other studies in 1993 and 1994 showed a link be- 
tween the disorder and diet, dyes, and preservatives. In 
another study in 1996, ADHD was linked to maternal 
smoking during pregnancy. 

Psychologists and other mental health professionals 
typically use the criteria listed in the Diagnostic and Sta- 
tistical Manual of Mental Disorders, Fourth Edition 
(DSM-IV) as a guideline for determining the presence of 
ADHD. For a diagnosis of ADHD, DSM-IV requires the 
presence of at least six of the following symptoms of 
inattention, or six or more symptoms of hyperactivity 
and impulsivity combined. 


• fails to pay close attention to detail or makes careless 
mistakes in schoolwork or other activities 

• has difficulty sustaining attention in tasks or activities 

• does not appear to listen when spoken to 

• does not follow through on instructions and does not 
finish tasks 

• has difficulty organizing tasks and activities 

• avoids or dislikes tasks that require sustained mental 
effort (like homework) 

• is easily distracted 

• is forgetful in daily activities 


• fidgets with hands or feet or squirms in seat 

• does not remain seated when expected to 


Attention-deficit hyperactivity disorder 

Attention-deficit hyperactivity disorder 

• runs or climbs excessively when inappropriate (in ado- 
lescents and adults, feelings of restlessness) 

• has difficulty playing quietly 

• is constantly on the move 

• talks excessively 


• blurts out answers before the question has been com- 

• has difficulty waiting for his or her turn 

• interrupts and/or intrudes on others 

DSM-IV also requires that some symptoms develop 
before age seven, and that they significantly impair func- 
tioning in two or more settings (e.g., home and school) for 
at least six months. Children who meet the symptom crite- 
ria for inattention, but not for hyperactivity/impulsivity are 
diagnosed with Attention-deficit/hyperactivity disorder, 
predominantly inattentive type, commonly called ADD. 
(Young girls with ADHD may not be diagnosed because 
they have mainly this subtype of the disorder.) 


The first step in determining if a child has ADHD is 
to consult with a pediatrician, a doctor who treats chil- 
dren. The pediatrician can make an initial evaluation of 
the child’s developmental maturity compared to other 
children in his or her age group. The doctor also should 
perform a comprehensive physical examination to rule 
out any organic causes of ADHD symptoms, such as an 
overactive thyroid or vision or hearing problems. 

If no organic problem can be found, a psychologist, psy- 
chiatrist, neurologist, neuropsychologist, or learning specialist 
typically is consulted to perform a comprehensive ADHD as- 
sessment. A complete medical, family, social, psychiatric, and 
educational history is compiled from existing medical and 
school records and from interviews with parents and teachers. 
Interviews also may be conducted with the child, depending 
on his or her age. Along with these interviews, several clinical 
inventories also may be used, such as the Conners Rating 
Scales (Teacher’s Questionnaire and Parent’s Questionnaire), 
Child Behavior Checklist (CBCL), and the Achenbach Child 
Behavior Rating Scales. These inventories provide valuable 
information on the child’s behavior in different settings and 
situations. In addition, the Wender Utah Rating Scale has been 
adapted for use in diagnosing ADHD in adults. 

It is important to note that mental disorders such as 
depression and anxiety disorder can cause symptoms 
similar to ADHD. A complete and comprehensive psychi- 
atric assessment is critical to differentiate ADHD from 
other possible mood and behavioral disorders. Bipolar 
disorder, for example, may be misdiagnosed as ADHD. 


Public schools are required by federal law to offer 
free ADHD testing upon request. A pediatrician also can 
provide a referral to a psychologist or pediatric specialist 
for ADHD assessment. Parents should check with their 
insurance plans to see if these services are covered. 


A 2003 survey showed that approximately 54% of 
parents reported using complementary or alternative 
medicine treatments for their children in the previous 
year. Some parents reported turning to these therapies 
because doctors don’t always agree on the ADHD diag- 
nosis and cannot adequately explain how allopathic drug 
treatments calm people and improve mental focus. Be- 
havior modification therapy uses a reward system to re- 
inforce good behavior as well as task completion and can 
be used both in the classroom and at home. A tangible 
reward such as a sticker may be given to the child every 
time he completes a task or behaves in an acceptable 
manner. A chart system may be used to display the stick- 
ers and visually illustrate the child’s progress. When a 
certain number of stickers are collected, the child may 
trade them in for a bigger reward such as a trip to the zoo 
or a day at the beach. The reward system stays in place 
until the good behavior becomes ingrained. 

A variation of this technique, cognitive-behavioral 
therapy, works to decrease impulsive behavior by getting 
the child to recognize the connection between thoughts 
and behavior, and to change behavior by changing nega- 
tive thinking patterns. 

Individual psychotherapy can help ADHD children 
build self-esteem, give them a place to discuss their worries 
and anxieties, and help them gain insight into their behavior 
and feelings. Family therapy also may be beneficial in help- 
ing family members develop coping skills and work 
through feelings of guilt or anger they may be experiencing. 

ADHD children perform better within a familiar, 
consistent, and structured routine with positive reinforce- 
ments for good behavior and real consequences for bad. 
Family, friends, and caretakers should be educated on 
the special needs and behaviors of the ADHD child. 
Communication between parents and teachers is espe- 
cially critical to ensuring an ADHD child has an appro- 
priate learning environment. 

A number of alternative treatments exist for ADHD. 
Although there is a lack of controlled studies to prove 
their efficacy, proponents report that they are successful 
in controlling symptoms in some ADHD patients. Some 
of the more popular alternative treatments are listed. 

• Electroencephalograph (EEG) biofeedback. By mea- 
suring brain wave activity and teaching the ADHD pa- 


tient which type of brain wave is associated with atten- 
tion, EEG biofeedback attempts to train patients to gen- 
erate the desired brain wave activity. 

• Dietary therapy. Based in part on the Feingold food al- 
lergy diet, dietary therapy focuses on a nutritional plan 
that is high in protein and complex carbohydrates and 
free of white sugar and salicylate-containing foods 
such as strawberries, tomatoes, and grapes. 

• Herbal therapy. Herbal therapy uses a variety of natural 
remedies to address the symptoms of ADHD. Ginkgo 
( Gingko biloba) is used for memory and mental sharp- 
ness and chamomile ( Matricaria recutita ) extract is 
used for calming. The safety of herbal remedies has not 
been demonstrated in controlled studies. For example, 
it is known that gingko may affect blood coagulation, 
but controlled studies have not yet evaluated the risk of 
the effect. 

• Vitamin and mineral supplements. Some vitamin and 
mineral supplements that are thought to be effective by 
some alternative practitioners include calcium, zinc, 
magnesium, iron, inositol, trace minerals, blue-green 
algae. Also recommended are the combined amino 
acids GABA, glycine, taurine, L-glutamine, L-pheny- 
lalanine, and L-tyrosine. In 2003, a study reported that 
a combination of omega-3 and omega-6 fatty acids 
supplements may help with cognitive and behavioral 
symptoms of ADHD. 

• Homeopathic medicine. This is probably the most effec- 
tive alternative therapy for ADD and ADHD because it 
treats the whole person at a core level. Constitutional 
homeopathic care is most appropriate and requires con- 
sulting with a well-trained homeopath who has experi- 
ence working with ADD and ADHD individuals. 

• Auricular acupuncture. A small study in 1997 indicat- 
ed that this type of acupuncture therapy might be effec- 
tive in some children. 

Allopathic treatment 

Psychosocial therapy, usually combined with medica- 
tions, is the treatment approach of choice to alleviate 
ADHD symptoms. Psychostimulants, such as dextroam- 
phetamine (Dexedrine), pemoline (Cylert), and 
methylphenidate (Ritalin) commonly are prescribed to 
control hyperactive and impulsive behavior and increase 
attention span. They work by stimulating the production of 
certain neurotransmitters in the brain. Possible side effects 
of stimulants include nervous tics, irregular heartbeat, loss 
of appetite, and insomnia. However, the medications usu- 
ally are well-tolerated and safe in most cases. But accord- 
ing to Carolyn Chambers Clark, R.N., Ed.D., 25% of the 
children with ADHD do not respond to stimulant drugs. 


In children who don’t respond well to stimulant 
therapy, tricyclic antidepressants such as desipramine 
(Norpramin, Pertofane) and amitriptyline (Elavil) are 
frequently recommended. Reported side effects of these 
drugs include persistent dry mouth, sedation, disorien- 
tation, and irregular heartbeat (particularly with de- 
sipramine). Other medications prescribed for ADHD 
therapy include buproprion (Wellbutrin), an antidepres- 
sant; fluoxetine (Prozac), an antidepressant; and carba- 
mazepine (Tegretol, Atretol), an anticonvulsant drug. 
Clonidine (Catapres), a medication for high blood pres- 
sure, also has been used to control aggression and hyper- 
activity in some ADHD children, although it should not 
be used with Ritalin. A child's response to medication 
will change with age and maturation, so ADHD symp- 
toms should be monitored closely and prescriptions ad- 
justed accordingly. 

In mid-2003, the first new drug for treating ADHD 
was about to become available. Called atomoxetine 
(Strattera), it was planned to offer several advantages 
over standard stimulants. First, atomoxetine is not a con- 
trolled substance, so physicians can write prescriptions 
for a larger number of pills and refills. Further, it doesn’t 
have the potential for abuse that the stimulant drugs pose. 

Expected results 

Untreated, ADHD negatively affects a child’s social 
and educational performance and can seriously damage 
his or her sense of self-esteem. ADHD children have im- 
paired relationships with their peers and may be looked 
upon as social outcasts. They may be seen as slow learn- 
ers or troublemakers in the classroom. Siblings and even 
parents may develop resentful feelings toward the 
ADHD child. 

Some ADHD children also develop a conduct disor- 
der problem. For those adolescents who have both ADHD 
and a conduct disorder, up to 25% go on to develop anti- 
social personality disorder and the criminal behavior, 
substance abuse, and high rate of suicide attempts that are 
symptomatic of it. Children diagnosed with ADHD also 
are more likely to have a learning disorder, a mood disor- 
der such as depression, or an anxiety disorder. 

Approximately 70-80% of ADHD patients treated 
with stimulant medication experience significant relief 
from symptoms, at least in the short-term. Approximate- 
ly half of ADHD children seem to “outgrow” the disor- 
der in adolescence or early adulthood. The other half 
will retain some or all symptoms of ADHD as adults. 
With early identification and intervention, careful com- 
pliance with a treatment program, and a supportive and 
nurturing home and school environment, ADHD children 
can flourish socially and academically. 


Attention-deficit hyperactivity disorder 



Conduct disorder — A behavioral and emotional 
disorder of childhood and adolescence. Children 
with a conduct disorder act inappropriately, in- 
fringe on the rights of others, and violate societal 

Nervous tic — A repetitive, involuntary action, 
such as the twitching of a muscle or repeated 



Alexander-Roberts, Colleen. The ADHD Parenting Handbook: 
Practical Advice for Parents from Parents. Dallas: Taylor 
Publishing Co., 1994. 

American Psychiatric Association. Diagnostic and Statistical 
Manual of Mental Disorders, 4th ed. Washington, DC: 
American Psychiatric Press Inc., 1994. 

Diller, Laurence H. Running on Ritalin: A Physician Reflects 
on Children, Society, and Performance in a Pill. New 
York: Bantam Books, 1998. 

Hallowell, Edward M., and John J. Ratey. Driven to Distrac- 
tion. New York: Pantheon Books, 1994. 

Kennedy, Patricia, Leif Terdal, and Lydia Fusetti. The Hyper- 
active Child Book. New York: St. Martin's Press, 1993. 

Maxmen, Jerrold S., and Nicholas G. Ward. “Disorders Usually 
First Diagnosed in Infancy, Childhood, or Adolescence.” 
In Essential Psychopathology and Its Treatment, 2nd ed. 
New York: W.W. Norton, 1995, 419-457. 

Osman, Betty B. Learning Disabilities and ADHD: A Family 
Guide to Living and Learning Together. New York: John 
Wiley & Sons, 1997. 


“Complementary, Alternative Medicine Being Used by Parents 
for ADHD.” The Brown University Child and Adolescent 
Psychopharmacology Update (August 2003): 1-3. 

Gaby, Alan R. “Essential Fatty Acids for ADHD.” Townsend 
Letter for Doctors and Patients (April 2003):43. 

Glicken, Anita D. "Attention Deficit Disorder and the Pediatric 
Patient: A Review.” Physician Assistant 2 1 . no. 4 (April 
1997): 101-111. 

Hallowell, Edward M. “What I've Learned from A.D.D." Psy- 
chology Today 30, no. 3 (May-June 1997): 40-46. 

Monaco, John E. “New Drug for ADHD." Pediatrics for Par- 
ents (June 2003):7-l 1. 

“New National ADHD Resource Center Opens in Maryland.” 
Special Education Report (June 2003): 12. 

“Parents Increasingly Seek Alternative ADHD Treatments.” 
Mental Health Weekly (September 22, 2003):7. 

Swanson, J.M., et al. “Attention-deficit Hyperactivity Disorder 
and Hyperkinetic Disorder.” The Lancet 35 1 (February 7, 
1997): 429-433. 



Children and Adults with Attention Deficit Disorder. 
(CH.A.D.D.). 499 Northwest 70th Ave., Suite 101, Planta- 
tion, FL 33317. (800) 233-4050. <> 
The National Attention Deficit Disorder Association. (ADDA). 
9930 Johnnycake Ridge Rd., Suite 3E, Mentor, OH 
44060. (800) 487-2282. <> 

The National Resource Center of ADHD. (800) 233-4050. 

Kim Sharp 
Teresa G. Odle 



Aucklandia, also known as costus or Mu Xiang , is the 
root of the plant Saussurea costus. Aucklandia has been 
used for centuries in Chinese and Indian herbal healing. 
More recently it has been used in Western aromatherapy. 

Aucklandia comes from a perennial plant that grows 
to about 6 ft (2 m) in height. It is native to northern India 
and Pakistan. This plant is also cultivated in other parts 
of India and in southwest China. The long, tapering root 
is harvested and dried for healing. 

In some regions of Asia, several other species of 
plant are used interchangeably with Saussurea costus. 
These include Saussurea lappa and Saussurea 
vladimirus. Locally, aucklandia is also called kuth, kust, 
kushta, qust-e-shereen, and patchak. 

General use 

Aucklandia is used in China and India to treat three 
main categories of complaints that center around the diges- 
tive system, the lungs, and infections. Aucklandia is used to 
treat symptoms such as nausea, vomiting, diarrhea, colon 
spasms, poor digestion, abdominal gas, and stomach pain. 
In laboratory studies, aucklandia has been shown to be an 
antispasmodic, accounting for its effectiveness against such 
symptoms as nausea and diarrhea. It is also sometimes used 
to treat gallstones and jaundice, although no scientific 
studies have confirmed its effectiveness for these uses. 

Aucklandia is used in many places in Asia to treat 
asthma, bronchitis, and uncontrolled cough. The anti- 
spasmodic component of the root extract causes the air- 
ways to relax and open more widely so that breathing 
becomes easier. This same property causes it to mildly 
lower blood pressure by relaxing the artery walls. How- 
ever, it does not lower blood pressure as effectively as 
some other herbs. 


In India, aucklandia is used primarily as an antisep- 
tic, an insecticide, and a fungicide. It is also said to be 
effective against yeast infections. Some research sug- 
gests that aucklandia may be effective against infections 
such as cholera and typhoid. 

A 1991 study published in the Journal of the Pak- 
istani Medical Association found that oral doses of an 
extract of the root of Saussurea lappa significantly re- 
duced nematode infestation in children. Nematodes are 
parasitic roundworms. Another 1998 study done in 
Korea found that an extract of Saussurea lappa killed 
tiny brine shrimp. One compound isolated in the brine 
shrimp investigation is known to be moderately effective 
in killing some types of human tumor cell types in labo- 
ratory settings. It appears that the use of aucklandia as an 
antiseptic has some basis in scientific fact. 

Other uses of aucklandia that have not been investi- 
gated in regulated scientific studies include using it as a 
treatment for water retention and lung tumors. In addi- 
tion to its medicinal uses, aucklandia is a fragrance and 
fixative in perfumes, shampoo, and hair dye. It is used in 
the Asian food industry to flavor alcoholic beverages, 
soft drinks, and sweets. 


Aucklandia can be prepared as either a distilled ex- 
tract or as an essential oil. The dried roots are chopped 
fine and softened in warm water, then distilled with 
steam. The resulting water-based distillate is then sub- 
jected to a solvent extraction to remove the active ingre- 
dients. The resulting yellow-brown fluid has a long-last- 
ing woody or musty odor. In Chinese medicine, aucklan- 
dia is classified as acrid and bitter. 

Aucklandia is used in formulas to treat both diges- 
tive and respiratory complaints. The best known of these 
formulas is Mu Xiang Shun Qi Wan. It is used to relieve 
pain and encourage digestion. Mu Xiang Shun Qi Wan is 
also used to treat chronic hepatitis, newly developed cir- 
rhosis of the liver, and abdominal pain. This formula is 
commercially available as pills, with the recommended 
dose of eight pills twice a day. 

Several other common formulas contain aucklandia. 
Ginseng and longan formula ( Gui Pi Tang ) is used to 
treat gastrointestinal upsets and various kinds of physical 
and emotional stress. Rhubarb and Scutellaria formula 
(Li Dan Plan) is used to treat gallstones. Tang Gui and 
indigo formula (Chien Chin Chih Tai Wan) is used to 
treat vaginal discharge and vaginal infections, as well as 
lower body pain. 

The oil of aucklandia is more commonly used in 
India than in China, and it is also used in Western aro- 



Antispasmodic — A substance that relieves spasm 
or uncontrolled contraction, usually of the smooth 
or involuntary muscle of the arteries, intestines, or 
the airways. 

Distillate — When a substance is distilled (vapor- 
ized and condensed to separate out different com- 
pounds), the material that is obtained through that 
process is called the distillate. 

Yin aspects — Yin aspects are the opposite of yang 
aspects and are represented by qualities such as 
cold, stillness, darkness, and passiveness. 

matherapy. It is applied externally or inhaled. The oil 
also is used by the cosmetic and perfume industry, where 
it blends well with other fragrances such as patchouli 
and floral fragrances. 


In Chinese medicine, aucklandia should not be used 
by people with deficient yin, which means people who 
are dehydrated or have a lot of dryness. 

Side effects 

When used externally, aucklandia causes skin irrita- 
tion (contact dermatitis) in some sensitive individuals. 


Aucklandia has been used safely in Asia as a medici- 
nal herb and a food and cosmetic additive for centuries. It 
is often used in conjunction with other herbs with no re- 
ported interactions. Since aucklandia has been used al- 
most exclusively in Asian medicine, there are no available 
studies of its interactions with Western pharmaceuticals. 



Lawless, Julia. The Illustrated Encyclopedia of Essential Oils. 
Rockport, MA: Element, 1995. 

Molony. David. Complete Guide to Chinese Herbal Medicine. 
New York: Berkeley Books, 1998. 


American Association of Oriental Medicine (AAOM). 433 
Front Street, Catasauqua, PA 18032. (610) 266-2433. 

Tish Davidson 



Auditory integration training 

Auditory integration training 


Auditory integration training (AIT), is one specific 
type of music/auditory therapy based upon the work of 
French otolaryngologists Dr. Alfred Tomatis and Dr. Guy 


The premise upon which most auditory integration 
programs are based is that distortion in how things are 
heard contributes to commonly seen behavioral or learn- 
ing disorders in children. Some of these disorders in- 
clude attention deficit/hyperactive disorder (ADHD), 
autism, dyslexia, and central auditory processing disor- 
ders (CAPD). Training the patient to listen can stimulate 
central and cortical organization. 

Auditory integration is one facet of what audiolo- 
gists call central auditory processing. The simplest defin- 
ition of central auditory processing, or CAP, is Universi- 
ty of Buffalo Professor of Audiology Jack Katz’s, which 
is: “What we do with what we hear.” Central auditory in- 
tegration is actually the perception of sound, including 
the ability to attend to sound, to remember it, retaining it 
in both the long- and short-term memory, to be able to 
listen to sound selectively, and to localize it. 

Guy Berard developed one of the programs com- 
monly used. Berard’s auditory integration training con- 
sists of twenty half-hour sessions spent listening to musi- 
cal sounds via a stereophonic system. The music is ran- 
dom, with filtered frequencies, and the person listens 
through earphones. These sound waves vibrate and exer- 
cise structures in the middle ear. This is normally done in 
sessions twice a day for 10 days. 

Alfred Tomatis is also the inventor of the Electronic 
Ear. This device operates through a series of filters, and 
reestablishes the dominance of the right ear in hearing. The 
basis of Tomatis’ work is a series of principles that follow: 

• The most important purpose of the ear is to adapt sound 
waves into signals that charge the brain. 

• Sound is conducted via both air and bone. It can be 
considered something that nourishes the nervous sys- 
tem, either stimulating or destimulating it. 

• Just as seeing is not the same as looking, hearing is not 
the same as listening. Hearing is passive. Listening is 

• A person's ability to listen affects all language develop- 
ment for that person. This process influences every as- 
pect of self-image and social development. 


• The capacity to listen can be changed or improved 
through auditory stimulation using musical and vocal 
sounds at high frequencies. 

• Communication begins in the womb. As early as the 
beginning of the second trimester, fetuses can hear 
sounds. These sounds literally cause the brain and ner- 
vous system of the baby to develop. 


A quartet of CAP defects have been identified that 

can unfavorably alter how each person processes sound. 

Among these are: 

• Phonetic decoding, a problem that occurs when the 
brain incorrectly decodes what is being heard. Sounds 
are unrecognizable, often because the person speaking 
talks too fast. 

• Tolerance-fading memory, a condition with little or 
poor tolerance for background sounds. 

•Auditory integration involves a person’s ability to put 
together things heard with things seen. Characteristi- 
cally there are long response delays and trouble with 
phonics, or recognizing the symbols for sounds. 

• The fourth problem area, often called auditory organi- 
zation, overlaps the previous three. It is characterized 
by disorganization in handling auditory and other infor- 

Certain audiological tests are carried out to see if the 

person has a CAP problem, and if so, how severe it is. 

Other tests give more specific information regarding the 

nature of the CAP problem. They include: 

• Puretone air-conduction threshold testing, which mea- 
sures peripheral hearing loss. If loss is found, then 
bone-conduction testing, or evaluation of the vibration 
of small bones in the inner ear, is also carried out. 

• Word discrimination scores (WDS) determines a per- 
son’s clarity in hearing ideal speech. This is done by 
presenting 25-50 words at 40 decibels above the per- 
son’s average sound threshold in each ear. Test scores 
equal the percentage of words heard correctly. 

• Immittance testing is made up of two parts, assessing 
the status of, and the protective mechanisms of the 
middle ear. 

• Staggered sporadic word (SSW) testing delivers 40 
compound words in an overlapping way at 50 decibels 
above threshold to each ear of the person being tested. 
This test provides expanded information that makes it 
possible to break down CAP problems into the four 
basic types. 



(Photograph by V. Brynner. Gamma Liaison. Reproduced by 

Internationally renowned French otolaryngologist, 
psychologist, educator and inventor Alfred Tomatis early- 
on perceived the importance of sound and hearing. He 
took his degree as a Doctor of Medicine from the Univer- 
sity of Paris and specialized in ear, nose and throat medi- 
cine. The son of two opera singers, Tomatis early in his 
career treated some of his parents' fellow opera singers. 
From these experiences with the sound of music, he de- 

veloped the principle that has come to be known as the 
Tomatis Effect, i.e. that the human voice can only sing 
what it hears. 

Tomatis has been called the Einstein of the ear. It 
was his research that made the world aware that the ears 
of an infant in utero are already functioning at four and 
half months of age. Just as the umbilical cord provides 
nourishment to the unborn infant's body, Tomatis postu- 
lated that the sound of the mother's voice is also a nutri- 
ent heard by the fetus. This sound literally charges and 
stimulates the growth of the brain. 

Dr. Tomatis took this further, into the realm of lan- 
guage. Tomatis concluded that the need to communicate 
and to be understood are among our most basic needs. 
He was a pioneer in perceiving that language problems 
convert into social problems for people. "Language is 
what characterizes man and makes him different from 
other creatures," Tomatis is quoted as saying. The tech- 
niques he developed to teach people how to listen effec- 
tively are internationally respected tools used in the treat- 
ment of autism, attention-deficit disorder, and other 
learning disabilities. 

His listening program, the invention of the Electronic 
Ear, and his work with the therapeutic use of sound and 
music for the past fifty years have made Tomatis arguably 
the best known and most successful ear specialist in the 
world. There are more than two hundred Tomatis Centers 
worldwide, treating a vast variety of problems related to 
the ability to hear. 

Joan Schonbeck 

• Speech in noise discrimination (SN) testing is similar to 
Staggered Sporadic Word testing except that other noise 
is also added and the percentage correct in quiet is com- 
pared with that correct when there is added noise. 

• Phonemic synthesis (PS) determines serious learning 
problems. The types of errors made in sounding out 
written words or associating written letters with the 
sounds they represent help in determining the type and 
severity of CAP problems. 


Upon completion of an auditory integration training 
program, the person’s hearing should be capable of per- 
ceiving all frequencies at, or near, the same level. Total 
improvement from this therapy, in both hearing and be- 
havior, can take up to one year. 


Research & general acceptance 

Auditory integration training is based upon newly 
learned information about the brain. Though brain structures 
and connections are predetermined, probably by heredity, 
another factor called plasticity also comes into play. Learn- 
ing, we now know, continues from birth to death. Plasticity 
is the ability of the brain to actually change its structuring 
and connections through the process of learning. 

Problems with auditory processing are now viewed 
as having a wide-reaching ripple effect on our society. It 
is estimated that 30-40% of children starting school 
have language-learning skills that can be described as 
poor. CAP difficulties are a factor in several different 
learning disabilities. They affect not only academic suc- 
cess, but also nearly every aspect of societal difficulties. 
One example to illustrate this is a 1989 University of 


Auditory integration training 

Aura therapy 

Buffalo study where CAP problems were found to be 
present in a surprising 97% of youth inmates in an up- 
state New York corrections facility. 

Training & certification 

Both Tomatis and Berard have certification pro- 
grams in their therapies. 



Katz, Jack, Ph.D., Wilma Laufer Gabbay, M.S., Deborah S. 
Ungerleider, M.A., and Lorin Wilde, M.S. Handbook of 
Clinical Audiology. Waverly Press, Inc., 1985. 


Katz, Jack, Ph.D. “Central Auditory Processing Evaluation." 

Masters, M. Gay. “Speech and Language Management of 
CAPD.” (1996). 

Musiek, Frank, Ph.D. "Auditory Training: An Eclectic Ap- 
proach.” American Journal of Audiology (1995). 


“Auditory Integration and Alfred Tomatis.” The Spectrum Cen- 
ter. < (December 2000). > 
Cooper, Rachel. “What is Auditory Integration Training?” (December 2000). 

Dejean, Valerie. About the Tomatis Method, 1997 . Tomatis Au- 
ditory Training Spectrum Center, Bethseda, MD. 

Masters, M. Gay and Jack Stecker Katz, N.A. Central Auditory 
Processing Disorders: Characteristic Difficulties. 

Miniseminar, 1994. 

Joan Schonbeck 

Aura therapy 


Aura therapy is a healing technique based on read- 
ing a person’s aura, or vital energy field, and then treat- 
ing diseases revealed by the aura color or colors. Aura 
therapy is generally considered a subtype of biofield 
therapy, which is a form of energy therapy that utilizes 
energies thought to reside in or emanate from the human 
body (as distinct from electromagnetic energy therapies). 
There are several variations of treatment, but in general 
aura therapy emphasizes manipulating the aura energy 
back into a positive balance. 


The exact origin of aura therapy is unknown, but 
historical references to it date back about 5,000 years. 


East Indian, Chinese, Jewish, and Christian faiths all 
have references to auras as energies that vibrate through 
physical matter. The energies are seen as colors and rep- 
resent such states of being emotional, mental, astral, and 
celestial. Halos have also been considered a kind of aura. 
Historically, it was believed that the special powers of a 
psychic, mystic, or clairvoyant were needed to see auras. 
Today, there are many New Age centers that teach the art 
of aura reading and therapy. 

In the late 1890s, the scientist and inventor Nicola 
Tesla (1856-1943) became the first person to photograph 
an aura. Auric photography took a big leap forward in 
the late 1930s when Semyon and Valentina Kirlian intro- 
duced a high-voltage imaging process that became 
known as Kirlian photography. Although there have 
been challenges to the use of Kirlian photography, the 
process was designed to photograph aura energy emitted 
by life forms, including plants, animals, and humans. A 
newer variation is aura imaging photography, which uses 
a special camera to take instant photos of a person’s 
aura. The size, shape, and color of the aura can then be 
analyzed to reveal specific physical, emotional, and 
mental problems. 

Types of aura therapy 

Since the early 1970s, several different forms of 
aura therapy have emerged within the alternative medi- 
cine field. Some brief descriptions follow. 

Aura color therapy 

Aura color therapy is more closely related to light 
therapy than to such other forms of aura therapy as ther- 
apeutic touch. In aura color therapy, the proportions of 
the colors in a person’s aura as well as their clarity or in- 
tensity are analyzed and treated. Aura color therapists 
maintain that the aura of a healthy person will have an 
undistorted oval shape around the body, with clear lines 
of light energy and a perfect balance of the seven colors 
of the rainbow. Muddy colors, bulges or swirls in the en- 
ergy lines, or an absence of any of the major colors signal 
energy imbalances. For example, a depressed person will 
have large amounts of blue and green in the aura with no 
orange or yellow. A chronically angry person will have 
too much red and little or no blue. 

Color therapy treatment consists of adding extra col- 
ors to a dull or depleted aura or using complementary 
colors to correct a color imbalance in the aura. For exam- 
ple, orange, which is the complementary color of blue, 
would be used to treat the aura of a depressed person. 
Several different techniques may be used to add or bal- 
ance the colors, the most common being the use of col- 
ored lights to irradiate the client’s body, or the placement 


of colored gemstones on the client’s body while he or she 
lies on the floor or on a massage table. In another varia- 
tion of aura color therapy, the client is advised to wear 
clothing in colors intended to balance or correct the aura. 

Therapeutic touch (TT) 

Therapeutic touch, or TT, is a form of energy thera- 
py that was developed in the United States in 1972 by 
Dora Kunz, a psychic healer, and Dolores Krieger, a pro- 
fessor of nursing at New York University. In TT, the 
practitioner alters the patient’s energy field through a 
transfer of energy from his or her hands to the patient. 
When illness occurs, it creates a disturbance or blockage 
in the aura or vital energy field. The TT practitioner uses 
her/his hands to discern the blockage or disturbance. Al- 
though the technique is called “therapeutic touch,” there 
is generally no touching of the client’s physical body, 
only his or her energetic body or biofield. TT is usually 
performed on fully clothed patients who are either lying 
down on a flat surface or sitting up in a chair. 

A therapeutic touch session consists of five steps or 
phases. The first step is a period of meditation on the 
practitioner’s part, to become spiritually centered and en- 
ergized for the task of healing. The second step is assess- 
ment or discernment of the energy imbalances in the pa- 
tient’s aura. In this step, the TT practitioner holds his or 
her hands about 2-3 inches above the patient’s body and 
moves them in long, sweeping strokes from the patient’s 
head downward to the feet. The practitioner may feel a 
sense of warmth, heaviness, tingling, or similar cues, as 
they are known in TT. The cues are thought to reveal the 
location of the energy disturbances or imbalances. In the 
third step, known as the unruffling process, the practi- 
tioner removes the energy disturbances with downward 
sweeping movements. In the fourth step, the practitioner 
serves as a channel for the transfer of universal energy to 
the patient. The fifth step consists of smoothing the pa- 
tient’s energy field and restoring a symmetrical pattern 
of energy flow. After the treatment, the patient rests for 
10-15 minutes. 

Tellington touch (Ttouch) 

Tellington touch, which is also known as Ttouch, is an 
interesting instance of an alternative therapy that began in 
veterinary practice and was later extended to humans. 
Ttouch was developed in England by Linda Tellington- 
Jones, a graduate of Feldenkrais training. The Feldenkrais 
method, which is usually considered a bodywork therapy, 
originated with Dr. Moshe Feldenkrais (1904-1984), a 
scientist and engineer who was also a judo instmctor. The 
Feldenkrais method is based on redirecting the client’s ha- 
bitual patterns of body movement, but it is unusual among 


bodywork therapies in its emphasis on new patterns of 
thinking and imagination as byproducts of the body’s reed- 
ucation. Tellington-Jones, who was employed as a horse 
trainer, began using Feldenkrais techniques on horses in 
1975. In 1983 she developed the pattern of circular touch- 
ing motions known as Tellington touch. 

In the 1980s, Ttouch expanded from treating behav- 
ioral problems in horses to treating cats, dogs, and other 
household pets. In the 1990s, Ttouch was introduced into 
nursing school curricula for the treatment of humans. It 
has been used to treat patients suffering from such 
chronic conditions as pain syndromes, Alzheimer’s dis- 
ease, arthritis, and multiple sclerosis as well as patients 
recovering from traumatic injuries or stroke. Ttouch is 
growing in popularity among hospice nurses as an alter- 
native treatment for patients facing death. 

In Ttouch, the practitioner touches the client’s skin 
but does not manipulate the underlying muscles or 
bones. The practitioner imagines the face of a clock on 
the client’s body and places a lightly curved finger at the 
6-o’clock position. He or she then pushes the skin clock- 
wise around the face of the clock for one and one-quarter 
circles, maintaining a constant pressure. The client’s 
body is gently supported with the practitioner’s free 
hand, which is placed opposite the hand making the cir- 
cle. After each circular touch, the practitioner gently 
slides the hand down the body and repeats the circle. 


Aura therapy is generally designed to bring imbal- 
ances in the aura back into physical, mental, emotional, 
and spiritual balance. The benefits can be subtle (like a 
general feeling of peace and well-being) or dramatic 
(like experiencing a spiritual transformation or feelings 
of ecstasy). Changes may be immediate or can occur 
over several days. Repeated therapy sessions can main- 
tain and deepen the aura energy balance. 

Persons who have received therapeutic touch or 
Tellington touch from nurses frequently mention “com- 
fort” or “humanizing of health care” as important benefits. 

Therapeutic touch and Tellington touch appear to 
benefit patients in intensive care units (ICUs), who fre- 
quently develop mild psychiatric disturbances from being 
isolated and from the fact that ICU equipment interferes 
with normal human sensory perception. It is thought that 
TT and Ttouch help to break down the patient's feelings 
of isolation and disconnection from other people. 


Traditionally, an aura is a protective psychic and 
spiritual energy field that surrounds the physical body. 


Aura therapy 

Aura therapy 

Energy from an aura is usually not static. It is constantly 
flowing, flashing, vibrating, expanding, and decreasing. 
The colors detected usually indicate emotions, such as: 

• lavender and purple for spirituality 

• red/orange for sexual passion 

• white for truth 

• rose or pink for love 

• red for anger 

• yellow for intellect 

Slow, deep breaths expand the aura while fast, shallow 
breaths decrease it. Spaces or gaps in the aura usually signi- 
fy disease. These gaps often appear near the affected area, 
such as around the heart to signify heart disease. In gener- 
al, auras have seven levels. Physical and ethereal auras ex- 
tend up to a foot from the body, imagination and emotional 
auras extend about two feet, while the mental, archetypal 
(destiny), and spiritual auras extend about three feet. 

There seems to be a general consensus among aura 
therapists that more than one session is required for opti- 
mal balancing. Many suggest three sessions within two 
or three weeks. The first session focuses on the physical 
aura, the next on the emotional, and the third on the spir- 
itual. Once the aura levels are in balance, follow-up ses- 
sions are encouraged every six months to a year. Aura 
therapy is not covered by medical insurance. The cost 
can range from $50 to $100 or more per session. 


No advance preparation is required. However, many 
aura readers and therapists say the patient should have a 
genuine desire for better health and happiness. Also, 
many therapists suggest patients abstain from recreation- 
al drugs, alcohol, and sex for several days before the 
therapy for a better sense of clarity and focus. 


There are no known precautions associated with 
aura therapy. 

Side effects 

No negative side effects associated with aura thera- 
py have been reported, although a small minority of pa- 
tients treated with TT or Ttouch report feeling uncom- 
fortable with being touched by strangers. 

Research & general acceptance 

Aura color therapy is considered a New Age treat- 
ment and is not generally accepted as valid by the con- 


ventional medical community. Skeptics argue that there 
are no scientific studies documenting the benefits of aura 
therapy or the existence of a human biofield. Most re- 
ports of the benefits of aura color therapy are anecdotal 
and appear in New Age journals and magazines. 

Although therapeutic touch has become a popular 
alternative/complementary approach in some schools of 
nursing in the United States and Canada, acceptance by 
the mainstream medical community varies. Many hospi- 
tals permit nurses and staff to perform TT on patients at 
no extra charge. On the other hand, however, therapeutic 
touch became national news in April 1998 when an ele- 
mentary-school student carried out research for a science 
project that questioned its claims. Twenty-one TT practi- 
tioners with experience ranging from one to 27 years 
were blindfolded and asked to identify whether the in- 
vestigator’s hand was closer to their right hand or their 
left. Placement of the investigator's hand was determined 
by flipping a coin. The TT practitioners were able to 
identify the correct hand in only 123 (44%) of 280 trials, 
a figure that could result from random chance alone. De- 
bate about the merits of TT filled the editorial pages of 
the Journal of the American Medical Association for 
nearly a year after the news reports. 

Tellington touch training is offered by some schools 
of veterinary medicine in the United States, and as of 
2003 is also offered in continuing education programs in 
schools of nursing. It appears to be gaining wider sup- 
port from the mainstream medical community as a useful 
technique in calming patients facing unpleasant or 
painful procedures. One study found that patients await- 
ing venipuncture who received Ttouch were more re- 
laxed before the procedure and had significantly less dis- 
comfort afterward. 

Training & certification 

No formal training or certification is required to 
practice aura reading, aura color therapy, TT, or Ttouch. 
However, a number of alternative medicine and New 
Age healing schools offer formal training and certifica- 
tion. Therapeutic touch and Tellington touch have their 
own training and certification programs. 



Bain, Gabriel Hudson. Auras 101 : A Basic Study of Human 
Auras and the Techniques to See Them. Flagstaff, AZ: 
Light Technology Publications, 1998. 

Bartlett, Sarah. Auras and How to See Them. London, UK: 
Collins & Brown, 2000. 

Chiazzari, Suzy. The Complete Book of Color: Using Color for 
Lifestyle. Health, and Well-Being, Part Six: Healing 
Through the Aura. Boston, MA: Element, 1998. 



Astral — Of or from the stars. 

Aura — An energy field that is thought to emanate 
from the human body and to be visible to people 
with special psychic or spiritual powers. 

Biofield therapies — A subgroup of energy thera- 
pies that make use of energy fields (biofields) 
thought to exist within or emanate from the 
human body. Biofield therapies include such ap- 
proaches as aura therapy, Reiki, therapeutic touch, 
qigong, and polarity balancing. 

Bodywork — Any healing technique involving 
hands-on massage or manipulation of the body. 

Clairvoyant — A person who has the power to see 
within their mind a future event or an event or 
thing out of their visual range. 

Ethereal — Something that is of or from the heav- 
ens, usually used in a metaphysical sense. 
Tellington touch (Ttouch) — A form of energy ther- 
apy that combines aspects of the Feldenkrais 
method of bodywork with aura therapy. 
Therapeutic touch (TT) — An American form of en- 
ergy therapy based on the ancient tradition of the 
laying-on of hands. TT is thought to work by re- 
moving energy blockages or disturbances from the 
patient's aura. 

Krieger, Dolores, Ph.D., R.N. Accepting Your Power to Heal: 
The Personal Practice of Therapeutic Touch. New York: 
Bear & Company, 1993. 

MacFarlane, Muriel. Heal Your Aura: Finding True Love by 
Generating A Positive Personal Energy Field. Secaucus, 
NJ: Citadel Press, 1999. 

Oslie, Pamela. Life Colors: What the Colors in Your Aura Re- 
veal. Novato, CA: New World Library, 2000. 

Snellgrove, Brian. The Magic in Your Hands: How to See Auras 
and Use Them for Diagnosis and Healing. Essex, UK: C. 
W. Daniel, 1998. 

Tellington-Jones, Linda, and Sybil Taylor. The Tellington 
Touch: A Breakthrough Technique to Train and Care for 
Your Favorite Animal. New York and London, UK: Pen- 
guin Books, 1995. 


Demmer, C., and J. Sauer. “Assessing Complementary Therapy 
Services in a Hospice Program.” American Journal of 
Hospice and Palliative Care 19 (September-October 
2002): 306-314. 

Hewitt, J. “Psychoaffective Disorder in Intensive Care Units: A 
Review.” Journal of Clinical Nursing 11 (September 
2002): 575-584. 


Rosa, Linda, MSN; Emily Rosa; Larry Sarner; and Stephen 
Barrett, MD. “A Close Look at Therapeutic Touch.” Jour- 
nal of the American Medical Association 279 (April 1, 
1998): 1005-11. 

“Somesthetic Aura: The Experience of Alice in Wonderland.” 
The Lancet (June 27 , 1998): 1934. 

Wendler, M. Cecilia. “Tellington Touch Before Venipuncture: 
An Exploratory Descriptive Study.” Holistic Nursing 
Practice 16 (July 2002): 51-64. 


Feldenkrais Guild of North America. 3611 S.W. Hood Avenue, 
Suite 100, Portland, OR 97201. (800) 775-2118 or (503) 221- 
6612. Fax: (503) 221-6616. <>. 

International Society for the Study of Subtle Energies and En- 
ergy Medicine (ISSSEEM). 356 Goldco Circle. Golden, 
CO 80401. (303) 278-2228. <http://www.vitalenergy. 
com/ISSS EEM.>. 

National Center for Complementary and Alternative Medicine 
(NCCAM) Clearinghouse. P.O. Box 7923, Gaithersburg, 
MD 20898. (888) 644-6226. TTY: (866) 464-3615. Fax: 
(866) 464-3616. <>. 

The Nurse Healers Professional Associates International (NH- 
PAI), the Official Organization of Therapeutic Touch. 3760 
S. Highland Drive, Salt Lake City, UT 84106. (801) 273- 
3399. <http://www.therapeu->. 

TTEAM/Ttouch in USA. P. O. Box 3793, Santa Fe, NM 87506. 
(800) 854-8326. <>. 

TTEAM/Ttouch in Canada. Rochdell Road, Vernon, BC V1B 
3E8. (250) 545-2336. <>. 


Auras website. The Healing Channel. <http://www.healing>. 

Ken R. Wells 
Rebecca J. Frey, PhD 



Auriculotherapy, also called ear acupuncture, ap- 
plies the principles of acupuncture to specific points on 
the ear. Auriculotherapists believe that healing processes 
can be promoted by working with these points on the ear, 
because the ear contains many blood vessels and nerve 
endings that, when stimulated, influence the organs and 
bodily functions. 


Acupuncture is one of the world’s oldest therapeutic 
techniques, having its roots in ancient China. Some of the 




oldest texts of Chinese medicine mention acupuncture 
points and massage techniques specifically for the ear. For 
eye problems, silver or gold earrings were sometimes pre- 
scribed in ancient times to provide constant healing stimu- 
lation at points on the ear, a practice that is still performed 
in some areas of the world, including parts of Europe. The 
ancient Egyptians and Greeks believed that working with 
the ears could influence health. Hippocrates, the Greek fa- 
ther of medicine, mentioned a point on the ear that could 
be operated on as a birth control measure in men. In Eu- 
rope in the Middle Ages, doctors prescribed surgery on a 
particular spot on the ear for a condition called sciatica, 
which causes nerve pain in the hips and thighs. 

In modern times, auriculotherapy has been advanced 
by Paul Nogier of France. Beginning his work and ex- 
periments in the 1950s, Nogier laid out an intricate map 
of points on the ear that correspond to the organs and 
processes in the body. Nogier believed that the ear is 
shaped like an upside down human fetus, and the 
acupuncture points on the ear correspond to the body 
parts of the fetus shape, with the earlobe representing the 
head. Nogier theorized that by stimulating these points 
on the ear, the corresponding organs and bodily process- 
es would be stimulated by nerve impulses. Nogier also 
theorized that by measuring electrical impulses on the 
skin of the ear, problems could be detected in the internal 
organs, and therefore auriculotherapy could be used to 
diagnose illnesses. Nogier and many followers, includ- 
ing ear acupuncturists in America and China, conducted 
scientific experiments in auriculotherapy, and showed 
some significant and surprising results in both treatment 
and diagnosis of conditions. In 2002, a center in Maine 
received a unique grant to study auriculotherapy for sub- 
stance abuse. Although recognizing that acupuncture had 
been used before for helping those with abuse, this study 
sought to show that auriculotherapy ’s effects on relax- 
ation response helped those abusing drugs and alcohol 
better deal with the anxiety and life circumstances 
thought to lead them to substance abuse. 


Auriculotherapy is a quick, inexpensive, and non-in- 
vasive method of pain control. Ear acupuncture is also 
used as anesthesia during medical procedures. It is used 
frequently to help people overcome drug, tobacco, and 
alcohol addictions, and is used to treat chronic health 
conditions and diseases. 


After an initial exam and interview, auriculothera- 
pists begin treatment by checking the patient’s ears 
closely. Practitioners may palpate (feel) the ears with 


their hands, and check for any irregularities or painful 
spots. They may check for spots that are insensitive or 
numb by using cold or hot needles on the ear. They may 
also rely on electrical devices that measure skin resis- 
tance at points on the ear. 

Several techniques may be used during auriculother- 
apy. Acupuncture needles are typically extremely thin. 
More than one needle may be used at one time, inserted 
deeply, or just pricked slightly along the contours of the 
ear. On some points, needles may be twisted or slanted 
to create more healing effects. Needles may be left in 
from a few minutes to half an hour or more. 

Auriculotherapists may use permanent press nee- 
dles. These small, tack-shaped needles may be attached 
to the ear with a narrow band of tape for several days or 
weeks. They are used for conditions that may require 
constant stimulation to acupuncture points on the ear, 
such as addictions, chronic (long-lasting) infections, and 
other health problems. 

Auriculotherapists also practice electroacupuncture, 
which utilizes electrical devices to send small electrical 
currents into the ear or through the body. Electroacupunc- 
ture is used for conditions such as paralysis or nerve dam- 
age in the body, drug and alcohol addictions, and chronic 
pain. Auriculotherapists may also employ bleeding, which 
removes one or two drops of blood at certain points on the 
ear. Bleeding is used for health problems such as high 
blood pressure, high cholesterol, or heart disease. 

Auriculotherapy is generally performed once per 
week on patients for a sequence of several months, al- 
though the frequency of treatment depends on the patient 
and condition. Treatment may last for several months. 
The initial visit to an acupuncturist is typically the most 
expensive, costing from $80 to $200. Follow-up visits 
are less expensive, from $50 to $100 on average. Auricu- 
lotherapists may also prescribe herbal and nutritional 
remedies. Insurance coverage of acupunture fees varies, 
depending on individual policies. 


Before treatment, an auriculotherapist may perform 
a thorough examination and interview the patient to de- 
termine health conditions and any precautions or adjust- 
ments that must be made. Acupuncturists often rely on 
pulse diagnosis and other diagnostic techniques before 
and during treatment. 

For treatment, the patient should lie in a horizontal 
position on a comfortable surface in a calm, stress-free 
environment. After treatment, the patient should be per- 
mitted to lie down until feeling capable of leaving the 
practitioner’s office. 


Acupuncture needles should be sterilized before use. 
The ears should be disinfected before acupuncture as 
well, which is usually done with a cotton ball dipped in 
rubbing alcohol. 


Auriculotherapy, like all acupuncture, should not be 
performed on weak or exhausted patients, nor on those 
who are very hungry or have just eaten a meal or drunk 
alcohol. Auriculotherapy should not be performed on 
pregnant women during the first two trimesters (six 
months) of pregnancy, and afterwards only on very par- 
ticular points on the ear for pain control. Auriculotherapy 
is not recommended for children under seven years old, 
and should be performed with care on the elderly. Ear 
acupuncture is to be avoided by those with anemia (low 
red blood cell quantity in the blood). Patients with ner- 
vous conditions should be thoroughly relaxed and pre- 
pared before treatment. For people that find acupuncture 
disagreeable, ear massage and acupressure may be 
preferable to treatment with needles. 

Side effects 

Some patients may experience uncomfortable side 
effects during or after acupuncture. Side effects that 
may occur after treatment include fainting, dizziness, 
nausea, numbness, headaches, sweating, or sharp pains 
throughout the body. These reactions may be due to 
anxiety or because acupuncture needles have been in- 
serted too deeply or in the wrong area. Side effects can 
be alleviated by removing the needles and allowing the 
patient to lie down under supervision. Some side effects 
that occur during treatment, such as hot flashes, in- 
creased pulse, and temporarily increased symptoms, are 
considered normal and usually disappear quickly. 

Training & certification 

The American Academy of Medical Acupuncture 
(AAMA) was chartered in 1987 to support the education 
and correct practice of physician-trained acupuncturists. 
Its members must be either MDs or DOs who have com- 
pleted proper study of acupuncture techniques. 

The National Commission for Certification of 
Acupuncturists (NCCA) conducts certification exams, 
promotes national standards, and registers members. 
Most states that license acupuncturists use the NCCA 
standards as certification. 

The American Association of Acupuncture and Ori- 
ental Medicine (AAAOM) is the largest organization for 
practitioners, with more than 1,600 members. 



Anesthesia — Method of pain control during med- 
ical procedures. 

Chronic — Referring to illness or condition that is 
long lasting. 



Fleischman, Dr. Gary. Acupuncture : Everything You Ever 
Wanted to Know. Barrytown, NY: Station Hill, 1998. 

Hicks, Angela. Thorson’s Principles of Acupuncture. New 
York: HarperCollins, 1997. 

Requena, Yves, MD. Terrains and Pathology in Acupuncture. 
Massachusetts: Paradigm, 1986. 


American Journal of Acupuncture. 1840 41st Ave., Suite 102, 
P.O. Box 610, Capitola, CA 95010. 

Savage, Lorraine. “Grant to Study Acupuncture’s Effectiveness 
on Patients Suffering from Substance Abuse." Healthcare 
Review. (March 19, 2002): 16. 


American Academy of Medical Acupuncture. 5820 Wilshire 
Blvd., Suite 500, Los Angeles, CA 90036, (213) 937-5514. 

American Association of Acupuncture and Oriental Medicine. 
433 Front St., Catasaugua, PA 18032, (610) 266-1433. 

National Commission for Certification of Acupuncturists. 1424 
16th St. NW, Suite 501, Washington, D.C. 20036, (202) 

Douglas Dupler 
Teresa G. Odle 



Autism is a chronic and often severe disorder of 
brain functioning that begins during childhood. It is 
marked by problems with social contact, intelligence, 
and language, coupled with ritualistic or compulsive be- 
havior, sensory integration and processing problems, and 
strange environmental responses. 


Autism is a lifelong disorder that interferes with the 
ability to understand what is seen, heard, and touched. 
This can cause profound problems in personal behavior 




Autistic children sometimes respond to behavioral and educational treatments in schools such as this one in Salt Lake City, 
Utah, that offers teachers specially trained to work with autistic children. (A/P Wide World Photos. Reproduced by permission.) 

and in the ability to relate to others. A person with 
autism must learn how to communicate normally and 
how to relate to people, objects, and events. However, 
not all patients suffer the same degree of impairment. 
The severity of the condition varies between individuals, 
ranging from the person with extremely unusual and ag- 
gressive behavior to one with something resembling a 
mild personality disorder or a learning disability. 

Autism occurs in as many as one in 1 ,000 children, 
and incidence is rapidly increasing. It is found three to 
four times more often in boys than in girls. The condi- 
tion occurs around the world in all races and all social 
backgrounds. Autism usually is evident in the first three 
years of life, although in some children it is difficult to 
pinpoint when the problem actually takes hold. Often, 
the condition may not be diagnosed until the child enters 
school. A person with autism can have symptoms rang- 
ing from mild to severe. 

Two subgroups of autism have recently been ex- 
plained by clinicians. Those with essential autism, as de- 
fined by diagnostic tests, appear to have higher IQ scores 
and fewer seizures than those with complex autism, 
which offers a poorer outcome. 


Causes & symptoms 

Although the exact causes of autism are unknown, 
many possibilities have been proposed. Most experts 
believe that several independent factors contribute to 
development of autism. The number and combinations 
of these factors probably differ from person to person. 
Research points to such precipitating conditions as fetal 
alcohol syndrome, genetic connections (as with identi- 
cal twins), brain stem defects, lead poisoning, a ner- 
vous system defect, infections, food and inhalant aller- 
gies, infant vaccination reactions, and digestive system 

Further studies point to major disturbances in the 
body chemistry of children with autism. Disruption is 
most often found in fatty acid metabolism, electrolyte 
balances, problems with digestive functioning, pro- 
duction of red and white blood cells, and the body’s 
balance of minerals. Diseases that may trigger autistic 
behavior include rubella in the pregnant mother, 
tuberous sclerosis, candiasis infection, fragile X syn- 
drome, encephalitis, cytomegalovirus (CMV), a se- 
vere form of a herpes simplex infection, and untreated 


There also appears to be a strong genetic basis for 
autism. In October 2001, the National Institutes of 
Health (NIH) reported that two regions of chromosomes 
contain genes involved with autism, and that two other 
chromosomes had a weaker relation to autism-related 
genes. Genetically identical twins are much more likely 
than fraternal twins to both have autism if one is affect- 
ed. In a family with one autistic child, the chance of hav- 
ing another child with autism is about one in 20, much 
higher than in the normal population. Sometimes, rela- 
tives of an autistic child have mild behaviors that look 
very much like autism, such as repetitive behaviors and 
social or communication problems. Research also has 
found that some emotional disorders, such as manic de- 
pression, occur more often in families of a child with 
autism. At least one group of researchers has also found 
a link between an abnormal gene and autism. The gene 
may be just one of at least three to five genes that inter- 
act in some way to cause the condition. Scientists sus- 
pect that a faulty gene or genes might make a person vul- 
nerable to develop autism in the presence of other fac- 
tors, such as chemical imbalance, infection, or a lack of 
oxygen at birth. 

Autism affects the way in which the brain uses or 
transmits information. Studies have found abnormalities 
in several parts of the brains of those with autism that al- 
most certainly occurred during fetal development. The 
problem may be centered in the parts of the brain re- 
sponsible for processing language and information from 
the senses. Profound problems with social interactions 
are the most common symptoms of autism. Infants with 
the disorder will not cuddle, avoid eye contact, and in 
general do not seem to like or require physical contact or 
affection. Often, the child will not form attachments to 
parents or the rest of the family. The child may not speak 
at all, or speak very little and may show bizarre patterns 
of speech, such as endlessly repeating words or phrases. 
About 10% of those with autism have an exceptional 
ability in particular areas, such as mathematics, memory, 
art, or music. 

Most autistic children appear to be mentally retard- 
ed to at least some degree. Bizarre behavior patterns are 
very common and may include repeated mimicking of 
the actions of others, complex rituals, screaming fits, 
rhythmic rocking, arm flapping, finger twiddling, and 
crying without tears. Many of these children may react 
to sounds by banging their head or flapping fingers. 
Some less affected autistic adults who have written 
books about their childhood experiences report that 
sounds were often excruciatingly painful to them, forc- 
ing them to withdraw from the environment or to try to 
cope by withdrawing into their own invented world. A 
common characteristic of individuals with autism is an 


insistence on sameness. There may be strong reactions to 
changes in food, clothing, and routines. 


Autism is diagnosed by obtaining a developmental 
history of the child and observing and evaluating the 
child’s behavior, communication skills, and social inter- 
actions. Because the symptoms of autism are so varied, 
the condition may go undiagnosed for some time. There 
is no medical test for autism. The condition is often 
missed, especially in mild cases or when additional hand- 
icaps are present. Special screening tools help physicians 
diagnose the condition. Medical tests are sometimes used 
to rule out other possible causes of autistic symptoms. 


Early intervention proves critical in managing 
autism. The American Academy of Pediatrics (AAP) 
says that many parents have chosen alternative therapies 
when more traditional therapies do not produce desired 
results. Among therapies mentioned in the group's report 
are nutritional supplements, elimination diets, immune 
globulin therapy, and secretin (a hormone) therapy. 

There is often a strong nutritional dysfunction in- 
volved in autism. A major overhaul of the child’s diet 
should be done, but very gradually. A healthy diet of 
whole foods with no preservatives or additives, including 
food dyes, is recommended. Autistic children may have 
particular difficulty handling Nutrasweet and monosodi- 
um glutamate (MSG), as these chemicals may further in- 
terfere with already disrupted nerve impulses. Processed 
foods such as white flour, white sugar, margarine, and 
hydrogenated fats should be avoided because they inter- 
fere with the stability of blood chemistry. 

Many autistic children may be unable to effectively 
break down the protein in grains such as wheat, barley, 
and oats, called gluten, and the protein in milk called ca- 
sein. Overgrowths of Candida albicans may be present 
and should be tested for and treated. Testing should also 
be done for food, chemical, and inhalant allergies. Di- 
gestive functioning should be tested and monitored. Ex- 
tensive testing should be done for blood levels of chemi- 
cals in the body, as well. Allergens should be subse- 
quently removed from the diet and environment; further 
dietary changes should be made to correct chemical im- 
balances. Possible gut and immune system dysfunction 
should also be addressed. 

Studies have shown that supplementation with mega- 
doses of vitamin B 6 together with magnesium improves 
eye contact, speech, and behavior problems. Vitamin B 6 
causes fewer side effects than other medications, but 




megadoses should only be given under the supervision of 
a healthcare provider. A B-complex vitamin is probably 
the best way to give B 6 , due to the interdependent func- 
tioning of the B vitamins. Zinc and vitamin C supple- 
mentation is also recommended. In addition, dimethyl- 
glycine (DMG) has been reported to improve speech in 
some children with autism in as little as a week’s time. 
Other therapeutic methods that have been shown to be 
helpful include special auditory integration training 
(AIT) based on the Berard method or the Tomatis method. 
Craniosacral therapy may also improve symptoms of 
autism by relieving compressions of the skull bones and 
membranes. Autism is a complex condition. A practitioner 
who has already worked with cases of autism successfully 
will be able to offer a comprehensive treatment plan. 

Allopathic treatment 

Most experts recommend a complex treatment regi- 
men for autism that begins early in life and continues 
through the teenage years. Behavioral therapies are used 
in conjunction with medications and special diets. Be- 
cause the symptoms vary so widely from one person to the 
next, there is not a single approach that works best for 
every person. Interventions include special training in 
music, listening, vision, speech and language, and senses. 
Sensory integration training may be used to normalize 
sensory functions. Training to change aberrant behaviors 
should be started as early in the autistic child’s life as pos- 
sible, since early intervention appears to have the most in- 
fluence on brain development and functioning. A child 
with autism is able to learn best in a specialized, struc- 
tured program that emphasizes individualized instruction. 

No single medication has yet proved highly effec- 
tive for the major features of autism. However, a variety 
of drugs can control self-injurious, aggressive, and other 
behaviors. Drugs also can control epilepsy, which af- 
flicts up to 20% of people with autism. Types of recom- 
mended medication may include stimulants, such as 
methylphenidate (Ritalin); antidepressants, such as 
fluroxamine (Luvox); opiate blockers, such as naltrexone 
(Re Via); antipsychotics; and tranquilizers. 

Expected results 

Studies show that people with autism can improve 
significantly with proper treatment. While there is no 
cure, the negative behaviors of autism can be made to 
improve. Earlier generations placed autistic children in 
institutions; now, even severely disabled children can be 
helped to eventually become more responsive to others. 
Children with autism usually can learn to better under- 
stand and deal with the world around them. Some can 
even lead nearly mainstream lives. 



Antidepressant — A type of medication that is used 
to treat depression; it is also sometimes used to 
treat autism. 

Asperger syndrome — Children who have autistic 
behavior but no problems with language. 

Encephalitis — A rare inflammation of the brain 
caused by a viral infection. It has been linked to 
the development of autism. 

Fragile X syndrome — A genetic condition related 
to the X chromosome that affects mental, physical, 
and sensory development. 

Phenylketonuria (PKU) — An enzyme deficiency 
present at birth that disrupts metabolism and caus- 
es brain damage. This rare inherited defect may be 
linked to the development of autism. 

Rubella — Also known as German measles. When 
a woman contracts rubella during pregnancy, her 
developing infant may be damaged. One of the 
problems that may result is autism. 

Tuberous sclerosis — A genetic disease that causes 
skin problems, seizures, and mental retardation. It 
may be confused with autism. 


The mechanisms of autism are poorly understood. 
There is currently no known method of prevention for 
the condition. However, there is much debate as to what 
part the measles, mumps, and rubella (MMR) vaccina- 
tion and the diphtheria, pertussis, and tetanus (DPT) 
vaccination may play in the onset of autism. A knowl- 
edgeable alternative healthcare provider should be con- 
sulted about the necessity of vaccination and possible al- 



Barron, Sean, and Judy Barron. There’s a Boy in Here. New 
York: Simon & Schuster, 1992. 

Bratt, Berneen. No Time for Jello. Massachusetttes: Brookline 
Books, 1989. 

Cohen, Donald J., and Fred R. Volkmar. Handbook of Autism 
and Pervasive Developmental Disorders. John Wiley & 
Sons, 1997. 

Cohen, Shirley. Targeting Autism: What We Know, Don't Know, 
and Can Do to Help Young Children with Autism and Re- 
lated Disorders. California: University of California 
Press, 1998. 


Hart, Charles. A Parent’s Guide to Autism: Answers to the Most 
Common Questions. New York: Pocket Books, 1993. 


Brunk D. “Three Tests Identify Two Autism Subgroups. (Two 
Types Termed Essential and Complex).” Pediatric News 
35, no. 12 (December 2001): 24. 

“Could New Changes be on the Horizon for Managing 
Autism?” The Brown University Child and Adolescent 
Behavior Letter 17, no. 7 (July 2001): 1. 

“Autism Genes Identified.” The Brown University Child and 
Adolescent Behavior Letter 17, no. 10 (October 2001): 1. 

Patience Paradox 
Teresa G. Odle 

Autoimmune arthritis see Ankylosing 

Ayurvedic medicine 


Ayurvedic medicine is a system of healing that origi- 
nated in ancient India. In Sanskrit, ayur means life or liv- 
ing, and veda means knowledge, so Ayurveda has been 
defined as the “knowledge of living” or the “science of 
longevity.” Ayurvedic medicine utilizes diet, detoxifica- 
tion and purification techniques, herbal and mineral 
remedies, yoga, breathing exercises, meditation, and 
massage therapy as holistic healing methods. Ayurvedic 
medicine is widely practiced in modern India and has 
been steadily gaining followers in the West. 


The three basic physiological principles or doshas. 

Illustration by GGS Information Services, Inc. The Gale Group. 

during the last two decades. Chopra is an M.D. who has 
written several bestsellers based on Ayurvedic ideas. He 
also helped develop the Center for Mind/Body Medicine 
in La Jolla, California, a major Ayurvedic center that 
trains physicians in Ayurvedic principles, produces 
herbal remedies, and conducts research and documenta- 
tion of its healing techniques. 

Ayurvedic medicine originated in the early civiliza- 
tions of India some 3,000-5,000 years ago. It is men- 
tioned in the Vedas , the ancient religious and philosophi- 
cal texts that are the oldest surviving literature in the 
world, which makes Ayurvedic medicine the oldest sur- 
viving healing system. According to the texts, Ayurveda 
was conceived by enlightened wise men as a system of 
living harmoniously and maintaining the body so that 
mental and spiritual awareness could be possible. Med- 
ical historians believe that Ayurvedic ideas were trans- 
ported from ancient India to China and were instrumen- 
tal in the development of Chinese medicine. 

Today, Ayurvedic medicine is used by 80% of the 
population in India. Aided by the efforts of Deepak 
Chopra and the Maharishi, it has become an increasing- 
ly accepted alternative medical treatment in America 


According to the original texts, the goal of Ayurveda 
is prevention as well as promotion of the body’s own ca- 
pacity for maintenance and balance. Ayurvedic treatment 
is non-invasive and non-toxic, so it can be used safely as 
an alternative therapy or alongside conventional therapies. 
Ayurvedic physicians claim that their methods can also 
help stress-related, metabolic, and chronic conditions. 
Ayurveda has been used to treat acne, allergies, asthma, 
anxiety, arthritis, chronic fatigue syndrome, colds, coli- 
tis, constipation, depression, diabetes, flu, heart disease, 
hypertension, immune problems, inflammation, insom- 
nia, nervous disorders, obesity, skin problems, and ulcers. 

Ayurvedic physicians seek to discover the roots of a 
disease before it gets so advanced that more radical treat- 



Ayurvedic medicine 

Ayurvedic medicine 

Ayurvedic physician uses a hot iron rod and fabric soaked 
in herbs to heal an arthritic hip, Bhubaneswar, India. (© 

Lindsay Hebberd/Corbis. Reproduced by permission.) 

ments are necessary. Thus, Ayurveda seems to be limited 
in treating severely advanced conditions, traumatic in- 
juries, acute pain, and conditions and injuries requiring 
invasive surgery. Ayurvedic techniques have also been 
used alongside chemotherapy and surgery to assist pa- 
tients in recovery and healing. 


Key ideas 

To understand Ayurvedic treatment, it is necessary 
to have an idea how the Ayurvedic system views the 
body. The basic life force in the body is prana, which is 
also found in the elements and is similar to the Chinese 
notion of chi. As Swami Vishnudevananda, a yogi and 
expert, put it, “Prana is in the air, but is not the oxygen, 
nor any of its chemical constituents. It is in food, water, 
and in the sunlight, yet it is not vitamin, heat, or light- 


rays. Food, water, air, etc., are only the media through 
which the prana is carried.” 

In Ayurveda, there are five basic elements that contain 
prana: earth, water, fire, air, and ether. These elements in- 
teract and are further organized in the human body as 
three main categories or basic physiological principles in 
the body that govern all bodily functions known as the 
doshas. The three doshas are vata, pitta, and kapha. Each 
person has a unique blend of the three doshas, known as 
the person’s prakriti, which is why Ayurvedic treatment is 
always individualized. In Ayurveda, disease is viewed as a 
state of imbalance in one or more of a person’s doshas, 
and an Ayurvedic physician strives to adjust and balance 
them, using a variety of techniques. 

The vata dosha is associated with air and ether, and 
in the body promotes movement and lightness. Vata peo- 
ple are generally thin and light physically, dry-skinned, 
and very energetic and mentally restless. When vata is 
out of balance, there are often nervous problems, hyper- 
activity, sleeplessness, lower back pains, and headaches. 

Pitta is associated with fire and water. In the body, it is 
responsible for metabolism and digestion. Pitta characteris- 
tics are medium-built bodies, fair skin, strong digestion, 
and good mental concentration. Pitta imbalances show up 
as anger and aggression and stress-related conditions like 
gastritis, ulcers, liver problems, and hypertension. 

The kapha dosha is associated with water and earth. 
People characterized as kapha are generally large or 
heavy with more oily complexions. They tend to be slow, 
calm, and peaceful. Kapha disorders manifest emotional- 
ly as greed and possessiveness, and physically as obesity, 
fatigue, bronchitis, and sinus problems. 


In Ayurvedic medicine, disease is always seen as an 
imbalance in the dosha system, so the diagnostic process 
strives to determine which doshas are underactive or over- 
active in a body. Diagnosis is often taken over a course of 
days in order for the Ayurvedic physician to most accu- 
rately determine what parts of the body are being affected. 
To diagnose problems. Ayurvedic physicians often use 
long questionnaires and interviews to determine a person’s 
dosha patterns and physical and psychological histories. 
Ayurvedic physicians also intricately observe the pulse, 
tongue, face, lips, eyes, and fingernails for abnormalities 
or patterns that they believe can indicate deeper problems 
in the internal systems. Some Ayurvedic physicians also 
use laboratory tests to assist in diagnosis. 


Ayurvedic treatment seeks to re-establish balance and 
harmony in the body’s systems. Usually the first method of 






Physical characteristics 


Average build 

Large build 

Prominent features 

Fair, thin hair 

Wavy, thick hair 

Cool, dry skin 

Warm, moist skin 

Pale, cool, oily skin 


Ulcers, heartburn, and hemorrhoids 

Obesity, allergies, and sinus 



High cholesterol 

Emotional characteristics 





Quick tempered 

Not easily angered 










Behavioral characteristics 

Unscheduled sleep 
and meal times 


Slow, graceful 

Nervous disorders 

Structured sleep and meal times 

Long sleeper and slow eater 




treatment involves some sort of detoxification and cleans- 
ing of the body, in the belief that accumulated toxins must 
be removed before any other methods of treatment will be 
effective. Methods of detoxification include therapeutic 
vomiting, laxatives, medicated enemas, fasting, and 
cleansing of the sinuses. Many Ayurvedic clinics combine 
all of these cleansing methods into intensive sessions 
known as panchakarma. Panchakarma can take several 
days or even weeks and they are more than elimination 
therapies. They also include herbalized oil massage and 
herbalized heat treatments. After purification. Ayurvedic 
physicians use herbal and mineral remedies to balance the 
body as well. Ayurvedic medicine contains a vast knowl- 
edge of the use of herbs for specific health problems. 

Ayurvedic medicine also emphasizes how people 
live their lives from day to day, believing that proper 
lifestyles and routines accentuate balance, rest, diet, and 
prevention. Ayurveda recommends yoga as a form of ex- 
ercise to build strength and health, and also advises mas- 
sage therapy and self-massage as ways of increasing cir- 
culation and reducing stress. Yogic breathing techniques 
and meditation are also part of a healthy Ayurvedic regi- 
men, to reduce stress and improve mental energy. 

Of all treatments, though, diet is one of the most basic 
and widely used therapies in the Ayurvedic system. An 
Ayurvedic diet can be a very well planned and individual- 
ized regimen. According to Ayurveda, there are six basic 


tastes: sweet, sour, salty, pungent, bitter, and astringent. Cer- 
tain tastes and foods can either calm or aggravate a particular 
dosha. For instance, sweet, sour, and salty decrease vata 
problems and increase kapha. Sour, salty, and pungent can 
increase pitta. After an Ayurvedic physician determines a 
person’s dosha profile, he or she will recommend a specific 
diet to correct imbalances and increase health. The 
Ayurvedic diet emphasizes primarily vegetarian foods of 
high quality and freshness, tailored to the season and time of 
day. Cooling foods are eaten in the summer and heating ones 
in the winter, always within a person’s dosha requirements. 
In daily routine, the heaviest meal of the day should be 
lunch, and dinner should be eaten well before bedtime, to 
allow for complete digestion. Also, eating meals in a calm 
manner with proper chewing and state of mind is important, 
as is combining foods properly and avoiding overeating. 


Costs of Ayurvedic treatments can vary, with initial con- 
sultations running anywhere from $40 to over $100, with fol- 
low-up visits costing less. Herbal treatments may cost from 
$10 to $50 per month, and are often available from health 
food or bulk herb stores. Some clinics offer panchakarma, the 
intensive Ayurvedic detoxification treatment, which can in- 
clude overnight stays for up to several weeks. The prices for 
these programs can vary significantly, depending on the ser- 
vices and length of stay. Insurance reimbursement may de- 
pend on whether the primary physician is a licensed M.D. 


Ayurvedic medicine 

Ayurvedic medicine 


(APAA/ide World Photos. Reproduced by permission.) 

Deepak Chopra was born in India and studied medi- 
cine at the All India Institute of Medical Science. He left 
his home for the United States in 1970 and completed 
residencies in internal medicine and endocrinology. He 
went on to teaching posts at major medical institutions — 

Tufts University and Boston University schools of medi- 
cine — while establishing a very successful private prac- 
tice. By the time he was thirty-five, Chopra had become 
chief of staff at New England Memorial Hospital. 

Disturbed by Western medicine's reliance on med- 
ication, he began a search for alternatives and discovered 
one in the teachings of the Maharishi Mahesh Yogi, an In- 
dian spiritualist who had gained a cult following in the 
late sixties teaching Transcendental Meditation (TM). 
Chopra began practicing TM fervently and eventually met 
the Maharishi. In 1 985 Chopra established the Ayurvedic 
Health Center for Stress Management and Behavioral 
Medicine in Lancaster, Massachusetts, where he began 
his practice of integrating the best aspects of Eastern and 
Western medicine. 

In 1993, he published Creating Affluence: Wealth 
Consciousness in the Field of All Possibilities , and the enor- 
mously successful best seller, Ageless Body. Timeless Mind. 
In the latter he presents his most radical thesis: that aging 
is not the inevitable deterioration of organs and mind that 
we have been traditionally taught to think of it as. It is a 
process that can be influenced, slowed down, and even 
reversed with the correct kinds of therapies, almost all of 
which are self-administered or self-taught. He teaches 
that applying a regimen of nutritional balance, medita- 
tion, and emotional clarity characterized by such factors 
as learning to easily and quickly express anger, for in- 
stance, can lead to increased lifespans of up to 120 years. 


Ayurveda is a mind/body system of health that con- 
tains some ideas foreign to the Western scientific model. 
Those people considering Ayurveda should approach it 
with an open mind and willingness to experiment. Also, 
because Ayurveda is a whole-body system of healing and 
health, patience and discipline are helpful, as some con- 
ditions and diseases are believed to be brought on by 
years of bad health habits and require time and effort to 
correct. Finally, the Ayurvedic philosophy believes that 
each person has the ability to heal themselves, so those 
considering Ayurveda should be prepared to bring re- 
sponsibility and participation into the treatment. 


An Ayurvedic practitioner should always be consult- 
ed, particularly when using herbal preparations. Care 
should be taken to ensure that a trained practitioner pre- 
pares individualized remedies. In 2002, a New York City 
hospital emergency department cautioned other hospitals 


when they encountered a case of a patient who came in 
with severe abdominal pain, occasional vomiting, and 
eventually seizures. She had suffered severe lead toxicity 
from an ayurvedic compound. 

Side effects 

During Ayurvedic detoxification programs, some 
people report fatigue, muscle soreness, and general sick- 
ness. Also, as Ayurveda seeks to release mental stresses 
and psychological problems from the patient, some peo- 
ple can experience mental disturbances and depression 
during treatment, and psychological counseling may be 
part of a sound program. 

Research & general acceptance 

Because Ayurveda had been outside the Western sci- 
entific system for years, research in the United States is 
new. Another difficulty in documentation arises because 
Ayurvedic treatment is very individualized; two people 
with the same disease but different dosha patterns might 


be treated differently. Much more scientific research has 
been conducted over the past several decades in India. 
Much research in the United States is being supported by 
the Maharishi Ayur-Ved organization, which studies the 
Ayurvedic products it sells and its clinical practices. 

In 2002, India took steps to make some of its most 
important ayurvedic knowledge more widely available. 
Many outside groups had begun to exploit the ancient 
holistic practice’s remedies and companies were dupli- 
cating processes and formulas, but calling them their 
own. The Indian government appointed a task force in 
January 2000 to promote and develop traditional medi- 
cines and to prevent piracy of the country’s traditional 
medical knowledge. The task force developed a digital 
library with international and Indian languages describ- 
ing about 35,000 ayurvedic herbal processes and formu- 
lations to cure all kinds of diseases. The library became 
available in early 2003 on the Internet. 

Some Ayurvedic herbal mixtures have been proven 
to have high antioxidant properties, much stronger than 
vitamins A, C, and E, and some have also been shown in 
laboratory tests to reduce or eliminate tumors in mice 
and to inhibit cancer growth in human lung tumor cells. 
In a 1987 study at MIT, an Ayurvedic herbal remedy was 
shown to significantly reduce colon cancer in rats. An- 
other study was performed in the Netherlands with Ma- 
harishi Ayur-Ved products. A group of patients with 
chronic illnesses, including asthma, chronic bronchitis, 
hypertension, eczema, psoriasis, constipation, rheuma- 
toid arthritis, headaches, and non-insulin dependent di- 
abetes mellitus, were given Ayurvedic treatment. Strong 
results were observed, with nearly 80% of the patients 
improving and some chronic conditions being complete- 
ly cured. 

Other studies have shown that Ayurvedic therapies 
can significantly lower cholesterol and blood pressure in 
stress-related problems. Diabetes, acne, and allergies have 
also been successfully treated with Ayurvedic remedies. 
Ayurvedic products have been shown to increase short- 
term memory and reduce headaches. Also, Ayurvedic 
remedies have been used successfully to support the heal- 
ing process of patients undergoing chemotherapy, as these 
remedies have been demonstrated to increase immune sys- 
tem activity. The herb gotu kola has been reported to re- 
lieve anxiety and enhance memory. 

Training & certification 

In the United States, there is no standardized pro- 
gram for the certification of Ayurvedic practitioners. 
Many practitioners have primary degrees, either as 
M.D.s, homeopaths, or naturopathic physicians, with ad- 
ditional training in Ayurveda. 



Dosha — One of three constitutional types, either 
vata, pitta, or kapha, found in Ayurvedic medi- 

Meditation — Technique of calming the mind. 
Panchakarma — Intensive Ayurvedic cleansing and 
detoxification program. 

Prakriti — An individual's unique dosha pattern. 
Prana — Basic life energy found in the elements. 
Yoga — System of body and breathing exercises. 



Gerson, Scott M.D. Ayurveda: The Ancient Indian Healing Art. 
Boston: Element Books, 1993. 

Lad, Dr. Vasant. Ayurveda: The Science of Self-Healing. Wis- 
consin: Lotus Press, 1984. 

Lad, Dr. Vasant. The Complete Book of Ayurvedic Home Reme- 
dies. Minneapolis: Three Rivers Press, 1999. 

Tiwari, Maya. Ayurveda: A Life of Balance. Vermont: Healing 
Arts Press, 1995. 


“India to Publish Ayurvedic Tracts on the Internet in Six Lan- 
guages.” Nutraceuticals International (May 2002). 

Mandile, Maria Noel. “Gotu Kola: This Ayurvedic Herb May 
Reduce Your Anxiety Without the Side Effects of Drugs.” 
Natural Health (May-June 2002): 34. 

Traub SJ. et al. “85 Lead Toxicity Due to use of an Ayurvedic 
Compound.” Journal of Toxicology : Clinical Toxicology 
(April 2002): 322. 


American Institute of Vedic Studiess. P.O. Box 8357, Santa Fe, 
NM 87504. (505) 983-9385. 

Ayurveda Holistic Center. Bayville, Long Island, NY. (516) 759- 
7731 <http://www.Ayurvedahc. 

The Ayurvedic Institute. 11311 Menaul, NE Albuquerque, New 
Mexico 87112. (505)291-9698. 

Ayurvedic and Naturopathic Medical Clinic. 10025 NE 4th 
Street, Bellevue, WA 98004. (206) 453-8022. 

Bastyr University of Natural Health Sciences. 144 N.E. 54th 
Street, Seattle, WA 98105. (206) 523-9585. 

Center for Mind/Body Medicine. P.O. Box 1048, La Jolla, CA 
92038. (619) 794-2425. 

The College of Maharishi Ayur-Ved, Maharishi International 
University. 1000 4th Street, Fairfield, IA 52557. (515) 

National Institute of Ayurvedic Medicine. (914)278-8700. <> 


Ayurvedic medicine 

Ayurvedic medicine 

The Rocky Mountain Institute of Yoga and Ayurveda. RO. Box OTHER 

1091, Boulder, CO 80306. (303)443-6923. “Inside Ayurveda: An Independent Journal of Ayurvedic Health 

Care.” P.O. Box 3021, Quincy, CA 95971. <http://www.> 

Douglas Dupler 



Bach flower remedies see Flower remedies 
Back pain see Low back pain 

Bad breath 


Bad breath, also called halitosis, is an unpleasant 
odor of the breath. Usually it is due to poor hygiene, but 
it can be an indication of underlying health problems. 


Bad breath is likely to be experienced by most 
adults and many children, at least occasionally. Some 
people are strongly convinced that bad breath is present 
when it is not. Bad breath can have a significant impact 
on a person's social and professional life. 

Causes & symptoms 

Accumulation of plaque on the teeth is a major 
cause of bad breath. Plaque is a mucus film that mixes 
with food particles, saliva, and bacterial residue in the 
mouth. Bad breath can also be caused by any number 
of other problems. These include sores in the mouth, 
infected tonsils, tooth or gum disease, fermentation of 
food particles in the mouth, sinus infections, and 
badly cleaned dentures. Conditions that may cause 
bad breath are not only limited to the oral and nasal 
areas. Other possible sources of the problem might be 
indigestion, lung infection, kidney failure, tuberculo- 
sis, syphilis, liver disease, stomach and intestinal 
problems, stress, dehydration, zinc deficiency, and 

Cigarette smoking can also lead to bad breath, not 
only in the smoker, but also in someone constantly ex- 


posed to secondhand smoke. A diet high in fats, spicy 
foods, or one that includes coffee may contribute to un- 
pleasant breath odors. Medications causing dry mouth 
or dehydration may also be a source of problems, since 
the flow of saliva helps clean out the mouth. Antihista- 
mines, decongestants, antidepressants, anti-anxiety med- 
ications, diuretics, and some heart medications may have 
a dehydrating effect, and could be a cause of bad breath. 


The easiest way to determine if one has bad breath is 
to ask a friend who is trustworthy and discrete, or to ask a 
doctor or dentist. A test that can be attempted on one’s 
own, is to cup a hand over the mouth, exhale, and then in- 
hale through the nose while smelling the breath. A physi- 
cal examination by a doctor or dentist may be used to di- 
agnose other problems that may be causing the bad breath. 


Leaves of parsley, Petroselinum crispum; winter- 
green, Gaultheria procumbens; or peppermint. Mentha 
piperita; can be chewed to freshen the breath by the in- 
troduction of their aromatic substances into the lungs. A 
strong tea made of Echinacea spp.; myrrh, Commiphora 
molmol; and bloodroot, Sanguinaria canadensis; can be 
used as a daily mouthwash. Fresh apples, citrus fruits, 
and celery are also good foods for helping to clean out 
the mouth. Possible homeopathic remedies that may be 
useful for bad breath include Nux vomica and Kali phos- 
phoricum. Supplementing with zinc and vitamin C may 
also be of benefit. 

Allopathic treatment 

The most effective treatment of bad breath is to treat 
the cause. If bad breath is a continuing problem or there 
are other symptoms, such as bleeding gums, a doctor or 
dentist should be consulted. A medication change may 
be warranted if a prescription drug is contributing to bad 


Balm of Gilead 

breath. A physician should be consulted any time a 
change in medication is planned. 

Expected results 

Most bad breath can be treated successfully with 
good oral hygiene or medical care. Occasionally, a per- 
son may develop delusional or obsessive behavior re- 
garding breath odor problems, and mental health coun- 
seling may be appropriate. 


A healthy diet, high in fresh fruits and vegetables 
and whole grains, should be eaten. Processed foods such 
as sugar and white bread and grains contribute to plaque 
formation and should be avoided. Spicy foods such as 
onions, peppers, garlic, pastrami, salami, pepperoni, an- 
chovies, and others should be avoided. Plenty of water 
should be consumed throughout the day to avoid dehy- 
dration and dry mouth. Water should be consumed after 
taking any food or drink to wash away residues that may 
accumulate with plaque. 

The teeth should be brushed and flossed daily after 
meals. Toothbrushes should be changed monthly, since 
there may be a tendency for bacteria to accumulate on 
them. Baking soda is a good choice to use for cleaning 
the teeth when bad breath is a problem. The baking soda 
makes the mouth pH less hospitable to odor-causing bac- 
teria. Gentle brushing of the tongue should also be in- 
cluded in the routine of daily oral hygiene, since the 
tongue itself may harbor tiny particles of food. A device 
called a tongue blade can be useful for cleaning the 
tongue. It may be available from a store that sells Asian 
or Middle Eastern products. An oral irrigation device, 
such as a Water Pik, is recommended to more thoroughly 
remove food and debris from the teeth. Mouthwashes are 
often helpful, especially those containing zinc. A dentist 
should regularly check the health of the gums and teeth 
for disease. A dental hygienist should clean the teeth reg- 
ularly, especially if there is an increased tendency to 
form plaque. 



Rosenberg, M. “Clinical Assessment of Bad Breath: Current 

Concepts.” Journal of the American Dental Association 

127 (April 1996): 475-482. 


American Dental Association. Box 776, St. Charles, IL 60174- 


Patience Paradox 


Bai gou see Ginkgo biloba 
Bai thu see Atractylodes (white) 
Balding see Hair loss 

Balm of Gilead 


Balm of Gilead ( Commiphora opobalsamum, 
known as Populus candicans in the United States) is a 
substance used in perfumes that is derived from the 
resinous juices of the balsam poplar tree. The tree is a 
member of the Bursera family. The variety that is native 
to the continents of Africa and Asia is a small tree of 
10-12 ft (3-3.6 m)in height. The cultivated North Ameri- 
can variety can grow to heights of 100 ft (30 m). 

The herb’s name derives from the ancient region of 
Gilead in Palestine, known for the great healing powers 
of its balm. Balm of Gilead is mentioned several times in 
the Bible (e.g., Jeremiah 8:22). The writings of Pliny the 
Elder indicate that the tree was brought to Rome in the 
first century a.d. The historian Josephus recorded that 
the Queen of Sheba made a gift of balm of Gilead to 
King Solomon. 

General use 

In addition to being used in the composition of per- 
fumes, balm of Gilead is used to soothe ailments of the 
mucous membranes. It is taken internally to ease coughs 
and respiratory infections. The balm is also said to re- 
lieve laryngitis and sore throats. It can also be combined 
with coltsfoot to make a cough suppressant. 


The resin of the balsam poplar tree is collected 
when it seeps out of the tree during the summer months. 
Seepage increases when humidity levels are high. Slits 
may be made in the tree’s bark to collect the resin more 
rapidly. The bark and leaf buds are also collected. 

For the internal treatment of chest congestion, balm 
of Gilead is made into a tincture or a syrup. To make a 
syrup, the balm is combined with equal parts of elecam- 
pane, wild cherry bark and one-half part of licorice 
mixed with honey. The syrup can be taken by table- 
spoons as needed. 

For external treatment of bruises, swellings and 
minor skin irritations, the balm is combined with lard or 
oil and applied as needed. The bark, which contains 



Coltsfoot — A common weed, Russilago farfara, 
used to treat chest complaints. 

Elecampane — A perennial herb with large yellow 
flowers used primarily as a digestive stimulant. 
Resin — A sticky substance used for medicinal pur- 
poses and in the manufacture of varnishes, ob- 
tained from the bark of certain trees. 

Salicylic acid — A crystalline substance that is the 
active ingredient in aspirin. 

traces of salicylic acid, can be combined with willow and 
rosemary and used as a analgesic to relieve fevers, mus- 
cle aches and arthritic pain. 


The sale and use of herbs as medicines, including 
balm of Gilead, are not regulated by government 
agencies. Therefore, consumers should exercise cau- 
tion in purchasing and using herbs in this manner. 
Consultation with a physician or pharmacist is always 

Side effects 

In general, balm of Gilead is safe to use in small 
amounts for coughs and other minor health problems. 
Some people, however, may have allergic reactions to 
the resin. In addition, patients with kidney and liver dis- 
ease, as well as pregnant and nursing women, should 
avoid the internal use of balm of Gilead. 


Balm of Gilead has no known interactions with stan- 
dard pharmaceutical preparations. 



Elias, Jason, and Shelagh Ryan Masline. Healing Herbal 
Remedies. New York: Dell, 1995. 

Tierra, Michael. The Way of Herbs. New York: Pocket Books, 


Grieve, M. “Balsam of Gilead.” (December 2000). <http:// > 

Mary McNulty 


Balneology see Hydrotherapy 
Ban xia see Pinellia 



Barberry, Latin name Berberis vulgaris, is native to 
Europe, where it is commonly used as an ornamental 
shrub. It is also commonly grown in North America. Its 
close relative, Berberis aquifolium, is a native of North 
America, and is also known as Oregon grape. Native 
Americans originally taught settlers its value as a medic- 
inal herb. Two other species of the plant, Nepalese and 
Indian barberry, are native to those areas and possess 
similar qualities. 

Barberry is a perennial herb that is usually around 8 
ft (2.4 m) tall, but can grow up to 10 ft (3 m) high. It 
bears yellow flowers, red or black berries, and small 
rounded fleshy leaves. It flourishes in dry sandy soil, and 
prefers a sunny location. Research has established that 
the active alkaloids in barberry belong to the isoquinoline 
family. They are berberine, berbamine, oxyacanthine, 
bervulcine, columbamine, isotetrandrine, jatrorrhizine, 
magnoflorine, and vulvracine. Other components include 
resin, tannin, and chelidonic acid, among others. 

General use 

Barberry and other berberine-containing plants have 
been used throughout history for their medicinal proper- 
ties. Chinese medicine has records of such use dating back 
over 3,000 years. In addition to the fact that these plants 
have been tried and tested over time, recent research has 
indeed confirmed what herbalists have been teaching for 
millennia — berberine has remarkable properties. 

The berries of the barberry plant are traditionally 
used to make jams and jellies, and the plant is used to 
make a dye. However, its culinary use is only minor 
compared to its importance as a member of the herbal 
Materia Medica. 

The medicinal actions of barberry are traditionally 
classified as being cholagogue, hepatic, antiemetic, bitter 
and laxative. Its main active constituent, berberine, has 
recently been the subject of much research (it is the ac- 
tive constituent of a number of valuable herbs, barberry 
and goldenseal being two important examples), and has 
been proven effective against a variety of ailments. 

Barberry is chiefly valued as an efficient liver 
cleanser, due to its ability to correct liver function and 
promote the flow of bile. It is good for heartburn, stom- 




Barberry plant. (© PlantaPhile, Germany. Reproduced by permission.) 

ach upsets, including gastritis, ulcers and ulcerative 
bowel conditions, and is an effective appetite stimulant. 
It has also been recommended for renal colic and the 
treatment of renal calculi, where it is claimed to allay 
burning and soreness. 

The herb has significant antibacterial, antiviral 
and antifungal properties, and has even demonstrated 
antiprotozoal properties, so it is an extremely valuable 
weapon against infection and fever. It is recommend- 
ed for use against diarrhea, whether of non-specific 
type, such as gastroenteritis, or from an identified 
source such as cholera. It is also capable of inhibiting 
the growth of Giardia lamblia, Trichomonas vagi- 
nalis. and Entamoeba histolytica. In fact, barberry is 
capable of similar action to Metronidazole, a common 
antiprotozoal medication, but has the advantage of no 
side effects. 

Berberine, the active constituent of barberry, inhibits 
Candida and other fungal growth, but does not affect 
beneficial bacteria such as Acidophilus and Bifidus. Bar- 
berry is particularly useful for skin infections, for which 
it is often taken internally, and has even been found ef- 
fective against psoriasis. 


It is often used against bronchial infections, as it is 
capable of breaking down and dispersing mucous accu- 
mulations, and controlling further secretions. It is an ef- 
fective sedative, is capable of lowering blood pressure, 
and is an effective uterine stimulant. Barberry is also 
taken for gallstones and inflammation of the gallbladder. 
It has the ability to correct an enlarged spleen. 

Barberry is useful for correcting menstrual irregu- 
larities, correcting anemia, as a treatment for vaginitis, 
and even as a tonic for a hangover. It is a suitable med- 
ication for gouty constitutions. It is recommended for 
strengthening the patient during convalescence, as it acts 
as an immune stimulant. 

Barberry can be used to treat malaria and even 
Leishmaniasis, which is a protozoal infection. Nicholas 
Culpeper praised the barberry plant highly, and stated 
that the berries are just as useful as the bark. He recom- 
mended their use for the cure of ringworm, in addition to 
the ailments already mentioned. 

Because it is capable of increasing blood supply, 
barberry may be of use to those suffering from ventricu- 
lar heart defects. Berberine is used in China to treat 
white blood cell depression when caused by chemothera- 
py or radiation treatments. 



The bark of the roots or stems are the parts used 

The dried herb may be taken in a decoction, for 
which place one teaspoonful of the herb in a cup of water 
and bring to the boil. Leave for about fifteen minutes and 
drink. This may be taken three time daily. The decoction 
may also be used as a gargle in cases of sore throat. 

If a tincture is being used, 1-2 ml may be taken three 
times daily. 

Herbalists recommend that in cases of gallbladder 
disease, barberry combined with fringe tree bark and 
black root are an effective treatment. 

For an effective liver cleanse, herbalists recommend 
a combination of one part barberry, one part wild yam, 
one part dandelion, and one half part licorice root, sim- 
mered in one pint of water for ten minutes, then strained 
through a coffee filter. 

The bark is sometimes made into a poultice for the 
treatment of skin lesions, and a compress is useful for 
swollen eye lids and conjunctivitis. 


Barberry root should not be taken by pregnant 
women because of its stimulant effect on the uterus. 
Those with heart disease or chronic respiratory prob- 
lems should only take barberry after consultation with a 
herbalist, naturopath, or medical specialist. 

The cultivation of barberry is restricted in some areas, 
as it hosts and promotes stem rust, a scourge to cereal crops. 

If in any doubt, it is always best to consult a herbal 
practitioner regarding dosage of herbs. 

Side effects 

Berberine (an active ingredient of barberry), has 
been found to affect normal bilirubin in infants, so in 
theory, it may have an adverse effect on jaundice. 

Strong extracts may cause stomach upsets, so use of 
barberry for a period of more than two consecutive 
weeks is not recommended. 

Barberry, if taken to excess may cause nose bleeds, 
lethargy, kidney irritation, skin and eye inflammation, in 
addition to headaches and low blood sugar. 


Barberry, or any herb containing berberine, has been 
found to interact with Sumycin, Helidac (Tetrecycline), 
Vibramycin, Helidac (Tetracycline), Doxycycline, and 
Achromycin, causing them to be less effective, and to af- 
fect their absorption. 



Antiemetic — Prevents or alleviates nausea or 3 


vomiting. “ 

Bitter — Reduces toxins, fights infection and fever, 
and acts as a mild tonic. 

Cholagogue — Stimulates the flow of bile from the 
liver to the intestines. 

Decoction — A strong infusion of a herb in water, 
usually denoting that it is left to stand for longer 
than an infusion. 

Hepatic — Promotes the well being of the liver. 

Leishmaniasis — A disease of the tropics transmit- 
ted by sandflies. 

Laxative — Promotes evacuation of the bowels. 

Materia medica — A list of drugs or herbs used 

Protozoa — Single-celled organisms, many of them 
intestinal parasites. 

Ventricular — Pertaining to the two lower cham- 
bers of the heart. 



Culpeper, Nicholas. Culpeper’ s Complete Herbal. London: 
Bloomsbury Books, 1992. 

Duke, James A. The Green Pharmacy. New York: St. Martin's 
Paperbacks, 1998. 

Grieve, M. A Modern Herbal. London: Tiger Books Interna- 
tional, 1992. 


Hoffman, David L. "Barberry.” Healt World Online. <http://> 

Birdsall, Timothy and Gregory Kelly. "Berberine: Theraputic 
Potential of an Alkaloid found in several Medicinal plants.” 
In Alternative Medicine Review [online database] Vol. 2, 
no. 2 (March 1997). < 

Patricia Skinner 

Barley grass 


Barley grass is the leaf portion of the barley plant 
( Hordeum vulgare) that remains after the seeds have 




Barley grass 

been removed. As a grass, it is also known as a distichon, 
meaning that it grows in two separate ranks, or rows. The 
rows of barley grass are parallel to the central axis, form- 
ing a loose sheath over the stem, which is sometimes 
called the culm. This stem is hollow and jointed, and the 
seeds are ellipitical and furrowed. The barley plant, an 
annual that requires reseeding each year, reaches a 
height of up to 3 ft (about 1 m). The plant has an exten- 
sive history in human and animal nutrition. As a nutri- 
tional supplement, it is preferable to use young barley 
plants that have not yet developed seeds. 

General use 

The barley plant appears to have been used by the 
ancient Egyptians, Romans, and Vikings. It is believed 
that Columbus brought it to the Americas in 1493. Bar- 
ley seeds have been used in both human nutrition and 
medicine. When the seeds are boiled, they release a thick 
substance that soothes sore throats. Barley seeds are used 
for the preparation of malt extract, which has a high 
sugar content that makes it suitable as a flavoring agent 
in pharmaceutical preparations. 

Marketers make a number of claims regarding bar- 
ley grass, including: 

• It is the only vegetation on earth that can supply sole 
nutritional support from birth to old age. 

• Barley grass juice contains nutrients such as vitamins C 
and E, which are much more potent together than when 
taken separately. 

• Barley grass is high in calcium, iron, all essential 
amino acids, vitamin C, the flavonoids, vitamin B 12 , 
and a number of enzymes and minerals. 

• Barley grass can be used to treat disorders of the stom- 
ach and duodenum; pancreatitis; and as an anti-in- 
flammatory agent. 

• Barley grass contains superoxide dismutase (SOD), a 
powerful antioxidant enzyme that protects the cells 
against toxic free radicals. 

Although not substantiated, one source has claimed 
that barley grass is good for the following conditions: 

• skin diseases 

• hepatitis 

• asthma 

• anemia 

• diabetes 

• arthritis 

• obesity 

Barley grass contains vitamins, particularly B vita- 
mins, as well minerals such as potassium, calcium, iron, 


phosphorus, and magnesium. Enzymes contained in 
the plant include SOD and nitrogen reductase. The latter 
reduces nitrogen — an element commonly found in pro- 
tein — in a biological process. Although barley grass con- 
tains enzymes, the health benefits of these substances re- 
main unclear. Enzymes are proteins, which are normally 
broken down into their component chemicals during di- 
gestion. However, the enzymes found in raw foods re- 
main technologically unprotected from normal digestive 
processes. The medical literature is not consistent on 
whether any SOD is actually absorbed intact through the 
digestive tract. In fact, the percentage absorbed may be 
very small. Techniques are being developed to encapsu- 
late enzymes into other molecules. This will allow the 
enzymes to be absorbed intact, so that they will remain 
active following digestion. 

Barley grass and other cereal grasses may or may 
not be useful sources of natural vitamins and minerals. 
Evidence may be insufficient to justify claims that these 
products improve physical health or cure disease. Barley 
grass has not been reviewed by the United States Food 
and Drug Administration (FDA) or the German Commis- 
sion E. Nutrient concentration in barley grass products 
varies with the conditions under which the plant is 
grown. Like other natural supplements, commercial bar- 
ley grass is not standardized; therefore, different crops 
contain varying amounts of nutrients. Young barley grass 
plants appear to contain higher concentrations of nutri- 
ents than older plants. 

One well-publicized Chinese study reported that 
barley grass was beneficial in lowering cholesterol lev- 
els in patients with type 2 diabetes. This may be due to 
the plant’s antioxidant abilities. Similar results were 
achieved by other researchers who studied the antioxi- 
dant effects of red wine and tomato juice. 

Other health claims made for barley grass remain 
unconfirmed. For example, chlorophyll, the pigment 
found in barley grass and all green plants, may have 
some antibacterial effects. Chlorophyll reportedly in- 
hibits the growth of cancer cells under laboratory condi- 
tions, but its value in human health is unknown. 

Similarly, the claim that barley grass can provide 
full nutrition is subject to dispute. One researcher found 
that people on a vegan diet that included barley grass 
were likely to show reduced levels of vitamin B 12 , and to 
require supplementation with this essential nutrient. 


Barley grass is available in capsule, powder, and 
tablet formulations. Capsules are sold in strengths of 470 
mg, 475 mg, and 500 mg. Tablets are available in 350 
mg and 500 mg strengths. 



Amino acid — An organic compound containing 
an amino group (NH 2 ), a carboxylic acid group 
(COOH), and various side groups. Amino acids 
are bound together to form proteins. 

Diabetes type 2 — A form of diabetes mellitus that 
usually occurs in adults. The pancreas produces 
insulin, but the muscle cells are resistant to the ef- 
fects of the insulin. This was formerly called matu- 
rity (or adult) onset diabetes. 

Enzyme — A protein, produced by a living organ- 
ism, that functions as an organic catalyst (a chemi- 
cal that increases the speed of a reaction without 
being involved in the reaction itself). 

Vitamin — Any of various organic carbon-contain- 
ing substances that are essential in minute 
amounts for normal growth and activity of the 
body, and are obtained naturally from plant and 
animal foods. 


Barley grass may sometimes be rich in vitamin K, 
which interferes with the action of anticoagulants such 
as Coumadin (the brand name for warfarin, a drug used 
to treat and prevent blood clots). Other than an allergic 
reaction, there are no known adverse effects attributed to 
barley grass. 

Side effects 

There are no known side effects attributed to barley 


No drug interactions have been associated with bar- 
ley grass, with the exception of samples that are high in 
vitamin K (interferes with Coumidin). 



Lust J. The Herb Book. New York, NY: Bantam Books, 1984. 
Reynolds J., ed. Martindale The Extra Pharmacopoeia. 30th 
ed. London: The Pharmaceutical Press, 1993. 

Seibold, R. Cereal Grass, Nature’s Greatest Health Gift. New 
Canaan, CT: Keats Publishing Inc., 1991. 


Donaldson, M.S. “Metabolic Vitamin B 12 Status on a Mostly 
Raw Vegan Diet with Follow-up Using Tablets, Nutrition- 


al Yeast, or Probiotic Supplements.” Annals of Nutrition 
and Metabolism 44 (2000): 229-34. 

Gowri, J. W.. M. S. Turner, J. Nichols, et al. “Lipoprotein Oxi- 
dation for Individuals with Type 2 Diabetes Mellitus.” 
Journal of the American Colleee of Nutrition 18 (October 
1999): 451-61. 

Yu, Y. M„ Chang, W. C., Chang, C. T„ et al. "Effects of Young 
Barley Leaf Extract and Antioxidative Vitamins on LDL 
Oxidation and Free Radical Scavenging Activities in Type 
2 Diabetes.” Diabetes Metab. (April 28, 2002): 107-14. 


Alberta Barley Commission. #200, 3601A - 21 Street N.E. Cal- 
gary, Alberta T2E 6T5 CANADA. (403) 291-9111. (800) 
265-9111. Fax: (403) 291-0190. <http://www. 

albert abarley. com/kids/about . shtml> . 

Green Green 7925-A N Oracle Rd #281 Tucson, 
AZ 85704. (888) 773-9808. 

Herbal Information Center. 3507 Marsala Ct. Punta Gorda, FL 
33950 <>. 

Samuel Uretsky, Pharm.D. 

Bates method 


The Bates method, popularized in the early twenti- 
eth century by ophthalmologist William Horatio Bates, 
involves the use of therapeutic eye exercises. Bates 
claims these exercises will correct vision problems, thus 
alleviating the need for glasses or contact lenses. Patients 
practice eye exercises aimed at strengthening and train- 
ing their eye muscles in an effort to overcome such prob- 
lems as farsightedness (hyperopia), nearsightedness 
(myopia), and astigmatism. 


The method was devised by Bates, who was born in 
1860 in Newark, New Jersey. In 1885. he received his 
medical degree and began practicing in New York City. 
Over the years, he began to notice that eye conditions 
like myopia, which is caused by a refractive error, could 
become better or worse for no apparent reason. Based on 
this observation, he began to question a basic tenet of 
traditional ophthalmology, which held that once a person 
had a refractive error like myopia, the only way to cor- 
rect it was by wearing glasses. 

While traditional ophthalmologists believed that the 
lens was responsible for the eye’s focus. Bates main- 


Bates method 

Bates method 

tained that it was the muscles around the eye that caused 
the eye to focus. Thus, traditional ophthalmologists 
blamed problems like nearsightedness on a failure of the 
lens to properly focus, while Bates believed it was due to 
a dysfunction of the muscles surrounding the eyeball. 
Bates had come to this conclusion after performing eye 
surgery on cataract patients and finding that some of 
them could still see distance without glasses even though 
he had removed the lens from their eyes; therefore, he 
determined that the lens did not play a role in refractive 
errors such as myopia. 

At this point. Bates broke from his counterparts and 
began focusing his attention on the muscles surrounding 
the eye. He came to view eye problems as a result of 
poor evolution, believing that the eye had not kept up 
with human progress and had not evolved to allow read- 
ing. He also blamed problems on artificial light, which 
kept the eyes working longer hours each day than they 
were intended to. Bates developed a series of eye exer- 
cises to retrain the optic muscles to solve this evolution- 
ary glitch. 

Bates believed that eye strain caused vision to dete- 
riorate, and his treatment was simple: like any other 
muscles, the eye muscles need periods of rest and exer- 
cise in order to achieve optimal performance. He focused 
on the functioning of the six small muscles that control 
the eye’s shape. When they become tense, they gradually 
grow weak and result in nearsightedness, farsightedness, 
astigmatism, or “lazy eye.” 

The Bates method received acclaim several years 
after Bates’s death (1931), when author Aldous Huxley 
boasted that after two months on the Bates program, he 
went from being almost blind to being able to read with- 
out wearing glasses. 


An advantage of the Bates method is that the treat- 
ment is relaxing. Also, if patients stick to the routine and 
eye improvement is gained, they may benefit by being able 
to discard their corrective lenses, escaping a lifetime of 
costs for glasses, lenses, and contact solutions. The treat- 
ment is also much less invasive than refractive surgery, 
which is costly and has risks, just like any other operation. 


The Bates method maintains that vision problems 
are caused by physiological and psychological strains 
and therefore cannot be corrected by wearing glasses. He 
believed that a combination of rest and exercise would 
mend the eyes and devised several exercises aimed at 
strengthening and retraining the eye muscles. 


The exercises themselves are simple, but Bates 
stressed that it takes discipline and attention to detail in 
order to achieve improvement. Some of the principal ex- 
ercises of the Bates method are described below. 


Palming is aimed at calming the visual system. In 
this exercise, patients close their eyes and cover them 
with the palms of their hands, allowing the fingers to 
cross on the forehead. The hands should be cupped so 
that no pressure is put on the eyeballs. Next, the patient 
should open his or her eyes and see if any light is getting 
in. If so, the hands should be moved so that no light en- 
ters and then close the eyes again. The warmth of a per- 
son’s hands, combined with blocking out all light, will 
relax a pair of tense eyeballs. 

Sitting at a table is a good palming position. A per- 
son can place a cushion on the table on which to rest 
their arms, and should check the height to be sure their 
hands are not too high or too low. Lying on the back, 
with knees raised and feet flat on the floor, is also a good 
position. While palming, patients should imagine a re- 
laxing scene, such as a sunrise or ocean. 

A description of the exercise posted on the Bates As- 
sociation for Vision Education website suggests palming 
in 5- 10-minute sessions, at least once a day. If this is 
found unpleasant, a person can try mini-sessions, palm- 
ing for a period of 15 breaths, up to 20 times a day. Palm- 
ing may also help when the eyes become tired and bleary. 


Swinging is meant to train the eyes not to stare. 
Bates maintained that the rigidity of staring was bad for 
the eyes. To do this exercise, the patient should focus on 
a fixed object, then swing the head or the entire body 
from side to side while keeping the object in view by 
moving the head instead of the eyes. 

Test-card practice 

Based on the idea that practice makes perfect, this 
exercise involves practicing eye charts. Patients are 
asked to focus on a letter, then close their eyes and visu- 
alize the black letter for several seconds. After several 
sessions. Bates maintains, the letters will appear blacker 
and clearer. 


Sunning is aimed at reducing light sensitivity. Bates be- 
lieved the sun has a therapeutic effect, so patients are asked 
to close their eyes and face the sun. It is advised to sun only 
in the morning or evening and only for short periods of time. 



Centralization, or central fixation, is aimed at 
training the eye not to overstrain itself by taking in too 
much at once. This exercise involves training the eyes 
to focus on a single point, rather than an entire pic- 
ture. The eye has a point in the middle of the vision 
field where vision is sharpest. This exercise is aimed 
at training people to look only at that point. Patients 
are asked to look at an object piece by piece instead of 
trying to look at it in its entirety, which Bates main- 
tains is beyond the physical capabilities of the eye. 
Bates believed that looking at an entire picture created 
strain, causing bad eyesight. This is not an exercise 
per se, but rather something patients are asked to do 
all day long. 

Color days 

This involves spending the day focused on looking 
for a specific color. When looking at a color, patients are 
asked to focus on the color, not the form. Colors change 
every day. 

People interested in the Bates method can pay a pro- 
fessional trained in the method to teach them the exercis- 
es or they can simply read about them in books or on the 
internet for no cost. Bates believed that improvement 
would vary, depending on the degree of problem and a 
person’s devotion to doing the exercises. 


There are no pre-therapy procedures. 


People should be aware that the theory remains un- 
proven. This method should not be a substitute for ap- 
propriate medical treatment in the case of cataracts, 
glaucoma, and other eye diseases. 

Side effects 

There are no side effects, but patients should be cau- 
tious when using the sunning exercise, which may cause 
solar retinitis, or inflammation of the retina, causing per- 
manent damage. 

Research & general acceptance 

Though the Bates method was devised a century 
ago, it has never been tested in a clinical setting. At best, 
anecdotal evidence is all there is to substantiate its use. 

The orthodox ophthalmologists of Bates’s time, as 
well as those of today, have largely dismissed his theo- 



Astigmatism — An eye condition that causes a per- 
son to see distorted images due to an abnormality 
in the curvature of the eye's lens. 

Farsightedness — Being able to see more clearly 
those objects far away as opposed to those that 
are near. Also called hyperopic. 

Nearsightedness — Being able to see more clearly 
those objects that are near as opposed to those in 
the distance. Also called myopia. 

lies as based on flawed science. Traditional ophthalmol- 
ogists hold that the lens — not the eye muscles — is re- 
sponsible for focus and therefore cannot be fixed 
through a series of exercises. Traditional ophthalmolo- 
gists believe that problems like nearsightedness are 
anatomic conditions that cannot be fixed by strengthen- 
ing the eye muscles. 

As Philip Pollack noted in his book The Truth About 
Eye Exercises, Bates used testimonials and case histories 
depicting successful treatment as scientific proof his the- 
ory was sound. Pollack also lambasted Bates for describ- 
ing rare cases as the norm, using them as justification for 
his methods. 

The Bates method has not found widespread use 
and is generally not accepted by the medical establish- 
ment. In his book Health Education Authority Guide to 
Complementary Medicine and Therapies, A. Woodham 
cautions that the medical consensus is that “eye exer- 
cises can improve the sight in some cases, but these 
need a lot of dedication and perseverance. Do not ex- 
pect miracles.” 

Training & certification 

Natural vision improvement techniques, such as the 
Bates method, are generally taught by behavioral op- 
tometrists or vision therapists. Vision therapists may not 
necessarily be trained in optometry. It is possible, how- 
ever, to find practicing optometrists trained by the Bates 
Association for Vision Education, which offers courses 
on the method. 



Bates, W. The Bates Method for Better Eyesight without Glass- 
es. New York: Henry Holt & Co., 1987. 

Cheney, E. The Eyes Have It: A Self-Help Manual for Better 

Vision. York Beach, Maine: Samuel Weiser, Inc., 1987. 


Bates method 



Booth, Brian. “Nature Cures: Hydrotherapy, Bates Method." 

Nursing Times 91 no. 20 (May 1995): 42-43. 

Karatz, May Annexton. “William Horatio Bates, M.D., and the 
Bates Method of Eye Exercises.” New York State Journal 
of Medicine 75 no. 7 (June 1975): 1105-1110. 


College of Optometries in Vision Development. P.O. Box 285, 
Chula Vista, CA 91912. (619) 425-6191. Fax: (619) 425-0733. 


“Bates Method.” The Vision Improvement Site. 16 July 
2000. < 

“Fallacies of the Bates System.” 14 July 2000. <http://>. 

“Who Was Dr. Bates?” Bates Association for Vision Education. 
<>. 14 July 2000. 

Lisa Frick 



Bayberry, also known as wax myrtle, waxberry, or 
candelberry, is both a shrub and a tree. All members of 
the bayberry family are classified botanically as Myri- 
caceae, and many varieties are found all over the world, 
including Japan, South America, the West indies, the 
United Kingdom, and in the United States. 

American bayberry ( Myrica cerifera ) is a shrub that 
grows 3-8 ft (1-2.4 m) high. It is found in eastern North 
America, in marshes and bogs near sandy Atlantic 
coastal areas, as well as in similar areas along the shores 
of the Great Lakes. American bayberry is the variety 
most often mentioned by herbalists. 

American bayberry and its British Isles cousin, Eng- 
lish bog myrtle, are very alike in appearance, and grows 
to a similar height. Foliage is evergreen and consists of 
knife -blade shaped shiny leaves that have small spots on 
them. When crumpled in one’s hand, bayberry leaves 
and its bark produce a pleasant, balsamic aroma. Howev- 
er, they have a very bitter, astringent taste. The small 
berries are in globular clusters at stem junctions, crusted 
with a greenish-white waxy substance sprinkled with 
small black flecks. The exterior of bayberry root bark is 
mottled, with smooth reddish-brown cork underneath. 

General use 

Both American bayberry and English bog myrtle, 
besides sharing a similar appearance, have similar medi- 


cinal qualities. Like all bayberry varieties, they are clas- 
sified as astringent herbs. Some evidence suggests that 
these herbs have antimicrobial capabilities, in that they 
are able to prevent the development of pathogenic activi- 
ty from microbes, and are useful in regulating mucus in 
the body. 

Both varieties’ bark and roots contain starch, lignin, 
gum, albumen, tannic and gallic acids, astringent resin, a 
red coloring substance, a vaporous oil, and an acid simi- 
lar to saponin. Powdered bayberry root is useful as a 
bowel astringent in the treatment of diarrhea and colitis, 
a soothing and helpful gargle for the common cold or a 
sore throat, and as a douche in the treatment of leukor- 
rhea, an abnormal white or yellow mucoid discharge 
from the vagina or cervix. In the Herbal Materia 
Medica, bayberry root bark is classified as an astringent, 
a circulatory stimulant, as well as a diaphoretic, a reme- 
dy which dilates superficial capillaries and induces per- 
spiration, sometimes used to reduce fevers. 

The berries of both American bayberry and English 
bog myrtle, when boiled in water, produce myrtle wax, 
which is composed of stearic, palmitic, myristic, and 
oleaic acids. This is used in making bayberry-scented 
soaps and bayberry candles, which are fragrant, more 
brittle than bees’ wax candles, and are virtually smoke- 
less. Four pounds of berries produce approximately one 
pound of wax. A briskly stimulating shaving cream was 
also made from this bayberry wax. 

The wax’s modern medicinal uses were first discov- 
ered and came into use in 1722, and included the mak- 
ing of surgeon’s soap plasters. The water that the berries 
were boiled in during wax extraction, when boiled down 
to an extract, has been used in the North Country of 
England and Scotland for centuries as a treatment for 
dysentery. Narcotic properties are also attributed to bay- 
berry wax. 

In A Modern Herbal, that the leaves of English bog 
myrtle were commonly used in France to induce both 
menstruation and abortion. 

In China, bayberry leaves are infused to make a tea 
which is used both to relieve stomach problems, and as a 
cordial, which is a stimulating medicine or drink. 

A mouthwash particularly useful in inhibiting halli- 
tosis can be made from either the powdered root or 

Bayberry bark has traditionally been used to tan 
leather and dye wool. 

Bayberry branches have been used in lieu of hops in 
the fermentation of gale beer , popular in northern Eng- 
land, and reported to have more than the usual “thirst- 
quenching” ability. 


Bayberries. (Photo Researchers, Inc. Reproduced by permission.) 

Bayberries can be ground to use as spice, or added 
to broths. 

In the West Indies, Pimento acris, commonly called 
wild cinnamon or bayberry, is used in making both bay 
rum and oil of bayberry. 

M. pennsylvanica’ s root can be used to induce vom- 

The Brazilian species, Tabocas combicurdo , is de- 
scribed in A Modem Herbal as a “pick-me-up.” 


Bayberry preparations are made by collecting root 
bark in late fall or early winter, drying thoroughly, and 
either pulvarizing into a powder or chopping the bark. It 
should be stored in a tightly sealed containers, away 
from light. 

A decoction or tea is prepared by adding a teaspoon- 
ful of powdered bayberry bark to a cup of cold water and 
bringing this to a boil. If using chopped, not powdered, 
bark, the decoction is simmered. This tea is then left to 
steep for 15-20 minutes before drinking. It may be taken 
up to three times a day for a limited period of time, as 


chronic use at this dosage could damage a person’s kid- 
neys and liver. The same preparation can be used as a 
gargle for sore throat. 

Tincture of bayberry preparations are also available in 
some locales. Usual dosage is one-half teaspoonful in water. 


As noted previously, English bog myrtle has histori- 
cally been shown as having characteristics capable of in- 
ducing abortion. Its leaves, in nature, also have a poiso- 
nous, volatile oil present, which can be removed by boil- 
ing. Though no studies were found indicating the same 
capabilities for American bayberry, because of their 
many similarities, it should be assumed that neither Eng- 
lish bog myrtle nor American bayberry leaves should be 
ingested in their natural, unprepared state. Additionally, 
aforementioned dosages of a bayberry decoction or tea 
should not be taken on a chronic basis, as damage to the 
kidneys and liver could occur. 

Side effects 

Powdered bayberry root, if inhaled, can cause con- 
vulsive episodes of both sneezing and coughing. 




Several varieties of the bayberry family are used as 
emetics, which are agents used to induce vomiting, and 
can also cause nausea. 


To date, no reported interactions with either food, 
drug, or other herbal preparations have been found. 



Grieve, M. and C.F. Leyel Barnes. A Modern Herbal: The 
Medical, Culinary, Cosmetic and Economic Properties, 
Cultivation and Folklore of Herbs, Grasses, Fungi, Shrubs 
and Trees With All of Their Modern Scientific Uses. 
Bames and Noble Publishing, 1992. 

Hoffman, David and Linda Quayle. The Complete Illustrated 
Herbal: A Safe and Practical Guide to Making and Using 
Herbal Remedies. Bames and Noble Publishing, 1999. 
Thayer, Henry. Fluid and Solid Extracts. Geo.C. Rand & 
Avery, 1866. 

Joan Schonbeck 

Bearberry see Uva ursi 
Beard moss see Usnea 



Bedsores are the result of inflammation and damage 
caused by irritation to the skin and inhibited blood flow. 
The condition occurs when skin is rubbed against a bed, 
chair, cast, or other hard object for an extended period of 
time. Bedsores can range from mild inflammation to 
deep wounds that involve muscle and bone. Infections 
can be a serious complication to the condition. 


Bedsores are also called decubitus ulcers, pressure 
ulcers, or pressure sores. They often start out with shiny 
red skin that becomes itchy or painful, then quickly blis- 
ters and deteriorates into open sores. Once there is a 
break in the skin, there is a strong possibility of the sore 
becoming infected, causing further medical problems. 
Bedsores are most apt to develop over the bony promi- 
nences of the ankles, the hip bones, the lower back, the 
shoulders, the spinal column, the buttocks, and the heels 
of the feet. Bedsores are most likely to occur in people 
who must use wheelchairs or who are confined to bed. 


Bedsores are medically categorized by stages: 

• Stage I: The skin reddens, but it remains unbroken. 

• Stage II: Redness, swelling, and blisters develop. There 
is possibly peeling of the outer layer of the skin. 

• Stage III: A shallow open wound develops on the skin. 

• Stage IV: The sore deepens, spreading through layers 
of skin and fat down to muscle tissue. 

• Stage V: Muscle tissue is broken down. 

• Stage VI: The underlying bone is exposed, and there is 
danger of severe damage and infection. 

Causes & symptoms 

Bedsores most often happen when the most superfi- 
cial blood vessels are pressed against the skin and 
squeezed shut, closing off the flow of blood. If the sup- 
ply of blood to an area of skin is cut off for more than an 
hour, the tissue will began to die due to lack of oxygen 
and nutrients. Ordinarily, the layer of fat under the bony 
areas of the skin helps keep the blood vessels from being 
compressed in this way. Also, people have a normal im- 
pulse to change positions frequently when they are sit- 
ting or lying down, so the blood supply is usually not 
kept from any area of the skin for very long. Bedsores 
are most likely to occur in people who have lost the pro- 
tective fat layer or whose movement impulse is hindered. 

Friction or rubbing from poorly fitted shoes or 
clothing and wrinkled bedding often cause a sore to de- 
velop. Constant exposure to the moisture of urine, feces, 
and perspiration may also cause the skin to deteriorate. 
In such cases there is an increased the risk of skin infec- 
tion as well as sores. 

Risk factors for bedsores: 

• older than 60 years of age 

• heart disease 

• diabetes 

• diminished tactile sensation 

• incontinence 

• malnutrition 

• obesity 

• paralysis or immobility 

• poor circulation 

• prolonged bed rest 

• spinal cord injury 

• anemia 

• disuse atrophy 



Physical examination of the skin, medical history, 
and patient and caregiver observations are the basis of 
diagnosis. Any sign of reddening of the skin will be 
closely monitored. 


Contrasting hot and cold local applications can increase 
circulation to problem areas and help flush out waste prod- 
ucts, speeding the healing process. Hot compresses should 
be applied for three minutes, followed by 30 seconds of cold 
compress application, repeating the cycle three times. The 
cycle should always end with the cold compress. In addition, 
zinc and vitamins A, C, E, and B-complex should be taken 
to help maintain healthy skin and repair injuries. 

Herbal remedies 

A poultice can be made of equal parts of powdered 
slippery elm, Ulmus fulva: marsh mallow root. Althaea 
officinalis ; and Echinacea spp. The herbs should be 
blended together with a small amount of hot water and 
applied to the skin three or four times per day to relieve 
inflammation. Poultices used on broken skin or infected 
areas should never be reused. 

An infection-fighting rinse can be made by diluting 
two drops of essential tea tree oil, Melaleuca spp., in 
eight ounces of water. This should be used to bathe the 
wound when bandages are changed. 

An herbal tea made from Calendula officinalis can 
be used as an antiseptic wash and a wound healing agent. 
Calendula cream can also be applied to the affected area. 

A poultice made from goldenseal, Hydrastis 
canadensis, and water or goldenseal ointment can be ap- 
plied to areas of inflammation several times per day to 
heal the skin and prevent infection. 

Allopathic treatment 

A healthcare provider should be consulted whenever 
a person develops bedsores. An emergency situation may 
be indicated if sores become tender, swollen, or warm to 
the touch, if the patient develops a fever, or if the sore 
has pus or a foul-smelling discharge. 

For mild bedsores, treatment basically involves re- 
lieving pressure on the area and keeping the skin clean 
and dry. When the skin is broken, a non-stick covering 
may be used. A saline solution is often used to clean the 
wound site whenever a fresh bandage is applied. Disin- 
fectants are applied if the site is infected. The doctor may 
also prescribe antibiotics, special dressings or drying 
agents, and ointments to be applied to the wound. Heat 


A Bedsore. (Photograph by Michael English, M.D., Custom 
Medical Stock Photo. Reproduced by permission.) 

lamps are used quite successfully to dry out and heal the 
sores. Warm whirlpool treatments are sometimes also rec- 
ommended for sores on the arm, hand, foot, or leg. 

In a procedure called debridement, a scalpel may be 
used to remove dead tissue or other debris from the wound. 
Deep sores that don’t respond to other therapy may require 
skin grafts or plastic surgery. If there is a major infection, 
oral antibiotics may be given. If a bone infection, called os- 
teomyelitis, develops or infection spreads through the 
bloodstream, aggressive treatment with antibiotics over the 
course of several weeks may be required. 

Expected results 

With proper treatment, bedsores should begin to 
heal two to four weeks after treatment begins. Left un- 
treated, however, gangrene, osteomyelitis, or a systemic 
infection may develop. In the United States, about 
60,000 deaths a year are attributable to complications 
caused by bedsores. 


Prompt medical attention can prevent pressure sores 
from deepening into more serious infections. People 
whose movement or sense of touch is limited by disabili- 
ty and disease should be monitored to insure that the skin 
remains clean, dry, healthy. A bedridden patient should be 
repositioned at least once every two hours while awake. A 
person who uses a wheelchair should remember to shift 
the body’s position often or they should be helped to 
reposition the body at least once an hour. To avoid injury, 
it is important to lift, rather than drag, a person being 
repositioned. Wheelchair users should sit up as straight as 
possible, with pillows behind the head and between the 
legs if needed. Donut-shaped seat cushions should not be 
used because they may restrict blood flow. 





Disuse atrophy — Condition of muscles that have 
lost size, strength, and function due to lack of mo- 

Gangrene — A serious condition where there is 
decay or death of an organ, tissue, or bone caused 
by a lack of oxygen and nutrients and by bacterial 

Incontinence — Inability to control bladder or 
bowel movements. 

Inflammation — An immune reaction to tissue in- 
jury or damage, usually characterized by pain, 
swelling and redness. 

Poultice — Moistened herbs applied directly to a 
site of injury or infection. 

Tactile sense — Receiving information about the 
body and the environment via contact with the 
skin. When this is lost through illness, a person 
may receive injuries without being aware of it. 

Even slight friction can remove the top layer of skin 
and damage the blood vessels beneath it. Pillows or foam 
wedges can be used to keep the ankles from rubbing to- 
gether and irritating each other; pillows placed under the 
lower legs can raise the heels off the bed. To minimize 
pressure sores, there should be adequate padding in beds, 
chairs, and wheelchairs. Those who are bed-ridden can 
be protected by using sheepskin pads, specialized cush- 
ions, and mattresses filled with air or water. In addition, 
a 1997 study indicates that topical use of essential fatty 
acids can help the skin stay healthy. 



Berkow, MD, Robert, editor-in-chief, et al The Merck Manual 
of Medical Information, Home Edition. New York: Pocket 
Books, 1997. 

The Editors of Time-Life Books The Medical Advisor: The 
Complete Guide to Alternative and Conventional Treat- 
ments Virginia: Time-Life, Inc., 1996. 


Declair, V. Ostomy Wound Management 43, no. 5 (1997): 48-52. 


International Association of Enterstomal Therapy, 27241 La 
Paz Road, Suite 121, Laguna Niguel, CA 92656 
National Pressure Ulcer Advisory Panel, SUNY at Buffalo, 
Beck Hall, 3435 Main Street, Buffalo, NY 14214 

Patience Paradox 




Bedwetting, or enuresis, is a childhood condition of 
urinating in bed while asleep at night. It is a chronic condi- 
tion that often resolves by itself before the teenage years. 


One of the major tasks of toddlerhood is to learn 
how to achieve conscious control over the timing of uri- 
nation. Most children do not become fully toilet trained 
until they are about two to four years old. Before then, 
the parts of the nervous system in charge of bladder con- 
trol are not fully developed and functional. In general, 
boys take longer to learn to control their bladders than 
girls, and daytime bladder control is easier for a child 
than overnight bladder control. There is a genetic aspect 
to bedwetting, so that parents who once had the condi- 
tion often have children who wet the bed at night. 

Causes & symptoms 

Bedwetting is often due to the normal immaturity of 
the nervous system and the urinary system. For instance, 
up to age six, bedwetting is often due to nothing more 
than the bladder having a small capacity. In addition, the 
muscles that control the opening and closing of the ure- 
thra may not be sufficiently developed. Often it takes a 
while for a child learn recognition of bladder fullness, 
waking up, and going to the toilet. In most cases, urinary 
capacity and control increase over time, and the bedwet- 
ting problem will eventually be outgrown. 

Surprisingly, a big cause of bedwetting is lack of sleep. 
If a child is not sleeping enough hours, then there will be less 
of the light, rapid eye movement (REM) sleep, and more pe- 
riods of heavy, deep sleep. During the periods of deep sleep 
some children will have difficulty becoming aware of the 
urge to urinate and awakening to go to the toilet. 

Bedwetting may be a sign of allergic reactions, 
which end up irritating sphincter muscles around the ure- 
thra. This contributes to a loss of bladder control during 
sleep. Heavy snoring, mouth breathing, and night sweats 
may all be indications of the presence of allergies. 

Bedwetting can sometimes be due to emotional and 
psychological stress, including major life changes such as 
moving or a divorce. This usually leads to the type of bed- 
wetting called secondary enuresis, in which a previous 
level of accomplishment with bladder control is lost. In 
other words, a child who has been dry at night will sud- 
denly start wetting the bed again. This may indicate an un- 
derlying problem such as constipation, diabetes, physical 


defects in the urinary tract, sacral nerve disorders, a pelvic 
growth, urinary stasis, infection, kidney stones, or kidney 
damage. Secondary enuresis also frequently occurs in 
children who are being physically or sexually abused. A 
pediatrician should be consulted if the condition persists. 

Only about 1% of bedwetting is caused by a serious 
underlying problem. If the following symptoms are pre- 
sent, a pediatrician or a pediatric urologist should be 

• straining during urination 

• a burning feeling or other discomfort during urination 

• constant or recurrent dribbling of urine 

• cloudy or pink urine 

• bloodstains or other discharge on underpants or night- 

• an unpleasant urine odor 

• onset of abdominal pain, backache, or fever 

• constant thirst, especially at night 

• sudden loss of bladder control previously mastered 

• a child over the age of two who still shows no signs of 
being ready to learn bladder control 


When bedwetting is resistant to home treatments or 
when more serious symptoms are present, a visit should 
be made to a healthcare provider. This is especially war- 
ranted if the child is older than six. A thorough history and 
physical exam should be taken along with a urine sample. 
Analysis and culture tests can be done on the urine to de- 
termine if an infection is present. Further evaluations may 
be made using ultrasound, an x ray of the kidney, or a con- 
sultation with a urologist. If the bedwetting appears to be 
connected with issues of stress or family problems, a men- 
tal health consultation may be recommended. 


Sitting in a cool sitz bath (pelvic area only im- 
mersed) for about five minutes daily can tone up the ure- 
thral sphincter. This can be done using a bathtub filled 
with about two or three inches of water, having the child 
sit in a large basin of water or using a sitz basin (avail- 
able from larger drugstores and medical supply stores). 

“Hands-on” treatments such as acupressure, reflex- 
ology, and shiatsu can be used to relax the child, coun- 
teract stress, and improve the actions of the nervous sys- 
tem. Hypnotherapy can also be helpful in improving 
bedwetting. Among other things, the child will be given 
positive goal affirmations to say before going to bed. 


This should help make the urge to urinate during the 
night more conscious, and therefore encourage the child 
to awaken and go to the toilet. 

The best way to use homeopathy is o see a home- 
opath for individual prescribing. Equisetum 6c, may be 
useful, especially if there are dreams or nightmares con- 
nected with the bedwetting. For bedwetting in very ex- 
citable, outgoing children, which occurs soon after 
falling asleep, Causticum 6c may be recommended. The 
remedies should be given once per day at bedtime for up 
to two weeks. A practitioner should be consulted for 
more specific remedies. 

Herbal medicine 

A strong tea can also be made using equal parts of 
horsetail, Equisetum arvense; St. John’s wort; cornsilk, 
Zea mays; and lemon balm, Melissa ojfinalis. Two to 
three handfuls of the mixture should be placed in a quart 
or liter jar and then covered with boiling water. The tea 
should be allowed to steep overnight. The child should be 
given half a cup of the tea three times per day, with the 
last dose being given at least two hours before bedtime. 

Nettles, Urtica dioica, can be made into a pleasant 
tea and consumed throughout the day as a tonic for the 
kidneys. The tea can be mixed with equal parts of fruit 
juice as a pleasant drink for the child. 

Aromatherapy uses the essential oil of cypress, Cu- 
pressus sempervirens to treat chronic bedwetting. Sever- 
al drops of cypress oil should be put in olive oil for mas- 
sage. The oil should be rubbed onto the child’s stomach 
right before bedtime. 

Behavior modification programs may be suggested. 
In one type, alarms that are triggered by body moisture 
are worn overnight, waking the child at the first sign of 
bedwetting. The child can then go use the toilet to finish 
emptying the bladder. This will eventually train the child 
to awaken and use the toilet upon experiencing the sen- 
sation of a full bladder. Nighttime toilet training using 
the alarm may take up to four or five months to be effec- 
tive, however. Another program uses the child’s help 
with urinating before going to bed, recording wet and 
dry nights, changing wet clothing and bedding, and dis- 
cussing progress. Positive reinforcements, such as gold 
stars on a chart and other rewards, are given for nights 
that the child does not urinate in bed. 

Allopathic treatment 

If other treatments fail to work, treatment with medica- 
tion may be suggested. With the use of the drug 
imipramine, improvement will usually occur in the first 
week of treatment if it is going to be helpful. The drug can 



Bee pollen 


Antidiuretic — A substance that diminishes the for- 
mation of urine. 

Behavior modification — Therapy aimed at chang- 
ing behavior by substituting problem behaviors 
with more useful activities. 

Culture test — A laboratory test to grow samples of 
an infecting organism from discharge or samples 
of affected tissue. 

Diuretic — A substance that stimulates the forma- 
tion and excretion of urine. 

Rapid eye movement sleep — A stage of sleep dur- 
ing which dreams occur. This stage usually alter- 
nates with a heavier, more restful stage of sleep. 

Sitz bath — A hydrotherapy treatment for soaking 
the pelvic or genital areas. 

Urethra — The tube that drains urine from the 

Urologist — A physician who specializes in treat- 
ing problems of the urinary tract. 

be discontinued if it does not work within a week or after a 
month has gone by with no bedwetting. Unfortunately, re- 
lapses are very common with this treatment. Also, since 
imipramine is a strong drug, the blood needs to be tested 
every other week for abnormal side effects. A nasal spray 
containing Demopressin, an antidiuretic drug, has been 
shown to be effective in diminishing bedwetting. It is neces- 
sary to use the spray at least four to six weeks for maximum 
effectiveness. Demopressin also has negative side effects 
and is, therefore, only recommended for short-term use. 

Expected results 

Bedwetting is usually outgrown at some point. 
However, underlying disease conditions may have to be 
assessed and treated. 


Caffeine has a diuretic effect, and should be avoided. 
It is found in coffee, chocolate, tea, and many sodas. Food 
labels should be examined to determine caffeine content. 



The Editors of Time-Life Books. The Medical Advisor: The 
Complete Guide to Alternative and Conventional Treat- 
ments. Virginia: Time-Life, Inc., 1996. 

Kirchheimer, Sid and the editors of Prevention Magazine 
Health Books. The Doctors Book of Home Remedies II: 
Over 1 .200 New Doctor-Tested Tips and Techniques Any- 
one Can Use to Heal Hundreds of Everyday Health Prob- 
lems. Pennsylvania: Rodale Press, 1993. 

Lockie, Dr. Andrew and Dr. Nicola Geddes. The Complete 
Guide to homeopathy: The principles and Practice of 
Treatment with a Comprehensive Range of Self-Help 
Remedies for Common Ailments. London: Dorling 
Kindersley, Ltd., 1995. 


American Academy of Pediatrics, < 
bedwet.htm. > 

Medicinal Herbs Online, < 

Patience Paradox 

Bee pollen 


Bee pollen is the dust-size male seed found on the 
stamen of any flower blossom. The pollen collects on the 
legs of honeybees as they move from flower to flower. 
The bees secrete a number of enzymes into the pollen. 
Pollen is usually collected commercially by placing a spe- 
cial device at the entrance of beehives that brushes the 
substance from their hind legs into a collection receptacle. 

General use 

Bee pollen is among the oldest known dietary sup- 
plements. Its use as a rejuvenator and medicine date back 
to the early Egyptians and ancient Chinese. It has been 
called many things, from a fountain of youth to an “am- 
brosia of the gods.” The Greek physician Hippocrates, 
sometimes called the father of modern medicine, used it 
as a healing substance 2,500 years ago. It is rich in vita- 
mins, especially B vitamins, and contains trace amounts 
of minerals, elements, amino acids, and enzymes. 

The pollen is composed of 55% carbohydrates, 35% 
protein, 3% minerals and vitamins, 2% fatty acids, and 
5% other substances. It contains very small amounts of 
many substances considered to be antioxidants, includ- 
ing betacarotene, vitamins C and E, lycopene, selenium, 
and flavonoids. 

Proponents of bee pollen offer a wide range of claims 
regarding its nutritional and healing properties. These in- 
clude enhancing the immune system, controlling weight, 
relieving allergy symptoms, increasing strength, improv- 
ing sexual function, enhancing vitality and stamina, slow- 



mg the aging process, and prolonging life. None of these 
claims have been substantiated by scientific studies. 

Bee pollen is said to strengthen the immune system 
through its antioxidant properties. Antioxidants are used 
to deactivate free radicals in the body. Free radicals are 
byproducts of oxygen that can damage cells and are 
linked to many degenerative diseases, especially those 
associated with aging. They are also associated with the 
aging process itself. Antioxidants may block further 
damage and even reverse much of the cell oxidation al- 
ready done. Bee pollen is suggested to help counteract 
the effects of radiation and environmental pollutants that 
weaken the immune system, supporters say. 

In the January 2000 issue of Bee Online , an Internet 
publication of the American Apitherapy Society, Steve 
Schecter, naturopathic doctor, said bee pollen is benefi- 
cial in reducing the effects of radiation treatment in 
women with cancer. A group of 25 women undergoing 
treatment for uterine cancer also took 20 g (about two 
teaspoons) of bee pollen three times a day. The women 
reported improvements in their appetites and sense of 
well being, and less severe nausea associated with radia- 
tion therapy. Their serum protein levels increased and 
red and white blood cell counts also improved. 

Although many plant pollens can cause or exacer- 
bate allergies and hay fever, bee pollen can actually 
help reduce the symptoms of these conditions. Local bee 
pollen therapy is recommended to start before the allergy 
season begins and it may take a few weeks for the pollen 
to work. According to an article in the February 1998 
issue of Better Nutrition , an Oklahoma allergist success- 
fully used bee pollen to treat 22,000 patients with aller- 
gies. However, those allergic to bee stings may experi- 
ence severe (anaphylactic) reactions to the pollen. 

Bee pollen is often used by athletes to improve 
strength, endurance, energy, and speed. It is said to help 
muscles recover more quickly from exercise and to in- 
crease mental stamina. “Bee pollen is used by almost 
every Olympic athlete in the world,” said James Higgins, 
treasurer of the American Apitherapy Society, in an inter- 
view in the August 1999 issue of Better Nutrition. “It 
gives them more energy and better performance for events 
like marathons, and they aren’t as exhausted the next day.” 


It takes about two hours for bee pollen to be absorbed 
into the bloodstream. It is available in health food stores in 
gelatin capsules, tablets, and granules. Capsules and tablets 
generally contain 500-1000 mg of bee pollen. A 100-count 
bottle costs $5-8 on average. Granules are sold by the 
ounce or pound. A one-pound bag costs about $20. The 
recommended dosages for preventative purposes are an 


Bee pollen of various types. (Photo Researchers, Inc. Repro- 
duced by permission.) 

eighth to a quarter teaspoon of granules once a day to start, 
gradually increasing over a month to one to two teaspoons, 
one to three times a day. The dosage for short-term thera- 
peutic use is 3/8-3/4 teaspoon to start, increasing to three to 
six teaspoons, one to three times a day. The recommended 
preventative dosage for capsules is two 450-580 mg cap- 
sules, three to four times a day, and three times that dosage 
for therapeutic purposes. Bee pollen is also available in liq- 
uid, cream, salve, and tincture form, mainly for use on skin 
conditions, sores, pounds, and bruises. Bee pollen should 
not be heated, since it will lose its potency. 


Persons who are allergic to bee stings or products 
should not use bee pollen since it may cause a serious aller- 
gic reaction, including death. Anyone uncertain if they are 
allergic to bee pollen should sample only a few granules 
first to see if there is any type of reaction, or have an allergy 
test. Those using bee pollen to reduce hay fever should be 
sure to consume local bee pollen to obtain the best results. 

Side effects 

There are rare cases of minor side effects, such as 
gastrointestinal irritation and diarrhea, associated with 
ingesting bee pollen. 


Bee pollen has no known negative interactions with 
other drugs, vitamins, or supplements. 



Balch, James F. Prescription for Nutritional Healing. Avery 

Publishing Group, 1997. 

Elkins, Rita. Bee Pollen, Royal Jelly, Propolis, and Honey: An 

Extraordinary Energy and Health-Promoting Ensemble. 

Woodland Publishing, 1999. 


Bee pollen 

Behavioral optometry 


Antioxidant — A substance that opposes oxidation 
damage anywhere in the body caused by free oxy- 
gen radicals. 

Flavonoids — A group of about 5,000 substances, 
mostly derived from food, that have super antioxi- 
dant qualities. 

Free oxygen radicals — Also called free radicals, 
these are by-products of oxygen that cause oxida- 
tive damage to the body's cells. 

Gout — A disease causing inflammation of the 
joints, especially the knees, toes, and fingers due 
to the deposit of crystallized uric acid in the 

Stamen — The male fertilizing organ of flowering 
plants, bearing pollen. 

Uric acid — A compound that can form deposits in 
joints and tissues. This disease is known as gout or 

Geelhoed, Glenn W. and Jean Barilla. Natural Health Secrets 
From Around the World. Keats Publishing, 1997. 

Jensen, Bernard. Bee Well. Bee Wise. Bernard Jensen Publisher, 

Wade, Carlson. Carlson Wade's New Fact Book on Bee Pollen 
and Your Health. Keats Publishing, 1994. 


Adderly, Brenda. “The Latest Buzz on Products of the Hive.” 
Better Nutrition (August 1999): 42. 

Hovey, Sue. "One Pill Makes You Larger.” Women's Sports and 
Fitness (April 1997): 79-80. 

Satel, Sally and James Taranto. “Bogus Bee Pollen.” The New 
Republic (January 8, 1996): 24-26. 

Scheer, James.“Products of the Hive: Sticky, Sweet and Health- 
ful." Better Nutrition (February 1998): 60-63. 

Somer, Elizabeth.“Tasty Relief: The Benefits of Using Food as 
Nutrition." Men's Fitness (July 1998): 44-46. 


American Apitherapy Society. 5390 Grande Road, Hillsboro, 
OH 45133. (937) 364-1108. 
http ://www. apitherapy. org . 

Ken R. Wells 

Bee sting therapy see Apitherapy 
Bee stings see Bites and stings 

Behavioral medicine see Mind/Body 


Behavioral optometry 


Behavioral optometry is a system of eye care that 
emphasizes visual training as a way to improve the way 
a patient uses his or her eyes. Rather than simply pre- 
scribe lenses to compensate for eyesight weaknesses, be- 
havioral optometrists attempt to train the patient to see 
better across a range of different circumstances. 


Behavioral optometry traces its roots to the writings 
of Dr. William H. Bates, a New York City ophthalmolo- 
gist. Bates began writing in the 1920s about alternatives 
to the use of corrective lenses. He believed that many 
physical and emotional stresses caused vision problems, 
and that alleviating these stresses could improve vision. 
He noted that modern humans spend an inordinate 
amount of time doing close work such as reading, while 
the human eye may have been originally adapted for dis- 
tance vision. Bates devised a program of eye training 
that allowed patients to gradually improve their vision 
without glasses. The English novelist Aldous Huxley re- 
covered from near-blindness using Bates’s system, and 
wrote a book about his experience. Other optometrists 
built on Bates’s insights, supplementing his research and 
ideas. Some researchers focused on the fact that the need 
for corrective lenses rises in proportion to a person’s 
level of education. They concluded that the stress of 
reading was probably responsible for poor eyesight. Oth- 
ers noted that vision problems increase as cultures be- 
come increasingly industrialized and developed. Practi- 
tioners of behavioral optometry who built on and extend- 
ed Bates’s ideas include Dr. Raymond L. Gottlieb and 
Dr. Jacob Liberman, both influential authors and teach- 
ers. Behavioral optometrists are distinctly a minority in 
the field of optometry, but they can be found across the 
United States and worldwide. 


Behavioral optometrists promise many benefits 
from this way of treating vision problems. Perhaps the 
foremost is that people can learn to live without the dis- 
comfort and bother of wearing eyeglasses or contact 
lenses. Behavioral optometry also focuses on children, 
particularly those with learning difficulties. These chil- 
dren can benefit from learning to train their eyes and so 
overcome reading problems due to inability to concen- 
trate or inability to keep the eyes in place on the page. 
Behavioral optometry also tries to help patients deal with 
stress, so that vision training can lead to a more relaxed 


and healthy lifestyle. In addition, behavioral optometry 
has been used to develop the special visual acuity that is 
needed for sports; and some practitioners are trained to 
treat patients who have suffered vision trauma such as 
stroke, or to work with autistic or disabled children. 


Behavioral optometry aims to treat the whole patient, 
not just correct his or her vision. The first step in an ex- 
amination may be a wide-ranging series of tests and ques- 
tions, geared to determine the patient’s overall visual 
abilities. This term means not just how well the eyes read 
letters on a chart, but such broader areas of visual percep- 
tion as hand-eye coordination and color perception. Be- 
havioral optometrists will prescribe corrective lenses, but 
these are usually somewhat different from traditional 
glasses. The lenses are designed to relieve the stress 
caused by such close-focus work as reading or working at 
a computer. But for distance seeing, the lenses may not 
be as accurate as traditional lenses, since the behavioral 
optometrist seeks to teach the eyes to relearn distance vi- 
sion skills that have atrophied. Many behavioral op- 
tometrists prescribe lenses that include a series of small 
prisms, which are supposed to help the eyes develop bet- 
ter vision patterns. Behavioral optometrists also practice 
vision therapy, in which the optometrist works closely 
with the patient in step-by-step exercises to help the eyes 
relax and relearn lost skills. These are not merely eye ex- 
ercises, because exercising the muscles around the eye 
can fatigue them instead of strengthen them. The therapy 
might involve learning new skills such as juggling, draw- 
ing, dancing, or ball games, as well as relaxation tech- 
niques. The optometrist may also work with the patient to 
alter diet, sleep patterns, and lifestyle stress. 

Research & general acceptance 

Though behavioral optometrists are definitely a mi- 
nority within the field of optometry, a body of research 
supports their methods. This can be found in profession- 
al journals such as Journal of Behavioral Optometry and 
Journal of Optometric Vision Development. Bates’s 
method has been in use since the 1920s, and much anec- 
dotal evidence attests to its efficacy, including the dra- 
matic case of writer Aldous Huxley. Other patients and 
practitioners have written of their ability to function 
without glasses and overcome learning disabilities 
through behavioral optometry. And one of the major con- 
tentions of behavioral optometry is that conventional op- 
tometry does not cure the eye conditions it treats. My- 
opic patients are given glasses, and then a stronger pair 
of glasses, and then a stronger, as vision gradually wors- 
ens. Behavioral optometrists use this development as ev- 
idence that conventional optometry fails its patients. 



Ophthalmologist — A physician who specializes in 
treating diseases and disorders of the eye. 

Optometrist — A professional who examines the 
eyes for vision defects in order to fit the patient 
with corrective lenses or prescribe other appropri- 
ate treatment. 

Training & certification 

In the United States, there are three major training 
institutions for behavioral optometry. The College of Op- 
tometrists and Vision Development offers courses and 
examinations leading to an international certificate in be- 
havioral optometry. Clinical education workshops are of- 
fered by the Optometric Extension Program Foundation 
in Santa Ana, California. The Baltimore Academy of Be- 
havioral Optometry offers in-depth coursework in behav- 
ioral optometry to qualified optometrists. Only people 
who already have a degree in optometry can take these 
courses. Technicians also work with behavioral op- 
tometrists. These technicians need have no specific edu- 
cational background, but to become certified, they must 
work for 2,000 hours under a certified behavioral op- 
tometrist and pass a written and oral examination. 



Bates, William. The Bates Method for Better Eyesight Without 
Glasses. New York: Henry Holt & Co., 1981. 

Liberman, Jacob. Take Off Your Glasses and See. New York: 
Crown Publishers, 1995. 


Baltimore Academy of Behavioral Optometry. 16 Greenmeadow 
Drive, Suite 103. Timonium, MD 21093. (800) 447-0370. 
College of Optometrists in Vision Development. 353 H. Street, 
Suite C. Chula Vista, CA 91910. (888) 268-3770. 
Optometric Extension Program Foundation. 2912 South Daimler 
Street, Suite 100. Santa Ana, CA 92705. (949) 250-8070. 

Angela Woodward 

Behavioral therapy 


Behavioral therapy, or behavioral modification, is a 
psychological technique based on the premise that spe- 


Behavioral therapy 

Behavioral therapy 

cific, observable, maladaptive, badly adjusted, or self-de- 
structing behaviors can be modified by learning new, 
more appropriate behaviors to replace them. 


Reward and punishment systems have been used 
throughout recorded history in an attempt to influence 
behavior, from child rearing to the criminal justice sys- 
tem. Modern behavioral therapy began in the 1950s with 
the work of B.F. Skinner and Joseph Wolpe. Wolpe treat- 
ed his patients who suffered from phobias with a tech- 
nique he developed called systematic desensitization. 
Systematic desensitization involved gradually exposing a 
patient to an anxiety-provoking stimuli until the anxiety 
response was extinguished, or eliminated. 

Skinner introduced a behavioral technique he called 
operant conditioning. Operant conditioning is based on 
the idea that an individual will choose his behavior based 
on past experiences of consequences of that behavior. If 
a behavior was associated with positive reinforcements 
or rewards in the past, the individual will choose it over 
behavior associated with punishments. 

By the 1970s, behavior therapy enjoyed widespread 
popularity as a treatment approach. Over the past two 
decades, the attention of behavioral therapists has fo- 
cused increasingly on their clients’ cognitive processes, 
and many therapists have begun to use cognitive behav- 
ior therapy to change clients’ unhealthy behavior by re- 
placing negative or self-defeating thought patterns with 
more positive ones. 


Behavioral therapy can be a useful treatment tool in 
an array of mental illnesses and symptoms of mental ill- 
ness that involve maladaptive behavior, such as sub- 
stance abuse, aggressive behavior, anger management, 
eating disorders, phobias, and anxiety disorders. It is 
also used to treat organic disorders such as incontinence 
and insomnia by changing the behaviors that might be 
contributing to these disorders. 

Cognitive-behavioral therapy, an offshoot of behav- 
ioral therapy that focuses on changing maladaptive be- 
haviors by changing the faulty thinking patterns behind 
them, is a recommended treatment option for a number 
of mental disorders, including affective (mood) disor- 
ders, personality disorders, social phobia, 
schizophrenia, obsessive compulsive disorder (OCD), 
agoraphobia, post-traumatic stress disorder (PTSD), 
Alzheimer’s disease, and attention-deficit hyperactivi- 
ty disorder (ADHD). It is also frequently used as a tool 
to deal with chronic pain for patients with illnesses such 
as rheumatoid arthritis, back problems, and cancer. 


Behavioral therapy techniques are sometimes com- 
bined with other psychological interventions such as med- 
ication. Treatment depends on the individual patient and the 
severity of symptoms surrounding the behavioral problem. 


Behavioral therapy, or behavior modification, is 
based on the assumption that emotional problems, like 
any behavior, are learned responses to the environment 
and can be unlearned. Unlike psychodynamic therapies, 
it does not focus on uncovering or understanding the un- 
conscious motivations that may be behind the maladap- 
tive behavior. In other words, behavioral therapists don’t 
try to find out why their patients behave the way they do, 
they just teach them to change the behavior. 

initial treatment sessions are typically spent explain- 
ing the basic tenets of behavioral therapy to the patient 
and establishing a positive working relationship between 
therapist and patient. Behavioral therapy is a collabora- 
tive, action-oriented therapy, and as such, it empowers 
patients by giving them an active role in the treatment 
process. It also discourages overdependence on the ther- 
apist, a situation that may occur in other therapeutic rela- 
tionships. Treatment is typically administered in an out- 
patient setting in either a group or individual session. 
Treatment is relatively short compared to other forms of 
psychotherapy, usually lasting no longer than 16 weeks 
or sessions. 

There are a number of different techniques used in 
behavioral therapy to help patients change their behav- 
iors. These include: 

• Behavioral homework assignments. The therapist often 
requests that the patient complete homework assign- 
ments between therapy sessions. These may consist of 
real-life behavioral experiments where patients are en- 
couraged to try new responses to situations discussed in 
therapy sessions. 

• Contingency contracting. In conjunction with the pa- 
tient, the therapist outlines a written or verbal contract of 
desired behaviors for the patient. The contract may have 
certain positive reinforcements (rewards) associated with 
appropriate behaviors and negative reinforcements (pun- 
ishments) associated with maladaptive behavior. 

• Modeling. This is where the patient learns a new be- 
havior through observation. 

• Rehearsed behavior. The therapist and patient engage 
in role-playing exercises in which the therapist acts out 
appropriate behaviors or responses to situations. 

• Skills training techniques. The patient undergoes an ed- 
ucation program to learn social, parenting, or other rel- 
evant life skills. 


• Conditioning. The therapist uses reinforcement to en- 
courage a particular behavior. For example, a child 
with ADHD may get a gold star every time he stays fo- 
cused on tasks and accomplishes certain daily chores. 
The gold star reinforces and increases the desired be- 
havior by identifying it with something positive. Rein- 
forcement can also be used to extinguish unwanted be- 
haviors by imposing negative consequences (this is also 
called punishment and response). 

• Systematic desensitization. Patients are gradually ex- 
posed to a situation they fear, either in a role-playing 
situation or in reality. The therapist will employ relax- 
ation techniques to help them cope with their fear reac- 
tion and eventually eliminate the anxiety altogether. 
For example, a patient in treatment for agoraphobia, a 
fear of open or public places, will relax and then pic- 
ture herself on the sidewalk outside of her house. In her 
next session, she may relax herself and then imagine a 
visit to a crowded shopping mall. The imagery gets 
progressively more intense until eventually, the thera- 
pist and patient approach the anxiety-producing situa- 
tion in real life by visiting a mall. By repeatedly pairing 
a desired response (relaxation) with a fear-producing 
situation (open, public spaces), the patient gradually 
becomes desensitized to the old response of fear and 
learns to react with feelings of relaxation. 

• Flooding. Flooding is an accelerated version of system- 
atic desensitization, in which the patient is exposed di- 
rectly to the anxiety-provoking situation that he fears 
most (either through mental visualization or real life 
contact) in an effort to extinguish the fear response. 

• Progressive relaxation. As the name implies, progres- 
sive relaxation involves complete relaxation of the 
muscle groups of the body and calm and even breathing 
until the body is completely tension free. It is used by 
behavioral therapists both as a relaxation exercise to re- 
lieve anxiety and stress, and as a method of preparing 
the patient for systematic desensitization. Progressive 
relaxation is performed by first tensing and then relax- 
ing the muscles of the body, one group at a time. The 
therapist may suggest that the patient use one of many 
available instructional relaxation tapes for practicing 
this technique at home. 

Cognitive-behavioral therapy (CBT) integrates fea- 
tures of behavioral modification into the traditional cog- 
nitive restructuring approach. In cognitive-behavioral 
therapy, the therapist works with the patient to identify 
the thoughts that are causing distress, and employs be- 
havioral therapy techniques to alter the resulting behav- 
ior. Patients may have certain fundamental core beliefs, 
known as schemas, which are flawed and are having a 
negative impact on the patient’s behavior and function- 


ing. For example, a patient suffering from depression 
may develop a social phobia because he is convinced he 
is uninteresting and unlikable. A cognitive-behavioral 
therapist would test this assumption, or schema, by ask- 
ing the patient to name family and friends that care for 
him and enjoy his company. By showing the patient that 
others value him, the therapist exposes the irrationality 
of the patient’s assumption. He also provides a new 
model of thought for the patient to change his previous 
behavior pattern (i.e., I am an interesting and likeable 
person, therefore I should not have any problem making 
new social acquaintances). Additional behavioral tech- 
niques such as conditioning (the use of positive and/or 
negative reinforcements to encourage desired behavior) 
and systematic desensitization (gradual exposure to anxi- 
ety-producing situations in order to extinguish the fear 
response) may then be used to gradually reintroduce the 
patient to social situations. 

Additional treatment techniques that may be em- 
ployed with cognitive-behavioral therapy include: 

• Cognitive rehearsal. The patient imagines a difficult sit- 
uation, and the therapist guides him through the step- 
by-step process of facing and successfully dealing with 
it. The patient then works on practicing, or rehearsing, 
these steps mentally. Ideally, when the situation arises 
in real life, the patient will draw on the rehearsed be- 
havior to address it. 

• Journal therapy. Patients are asked to keep a detailed 
diary recounting their thoughts, feelings, and actions 
when specific situations arise. The journal helps to 
make the patient aware of his or her maladaptive 
thoughts and to show their consequences on behavior. 
In later stages of therapy, it may serve to demonstrate 
and reinforce positive behavior. 

• Validity testing. Patients are asked to test the validity of 
the automatic thoughts and schemas they encounter. 
The therapist may ask the patient to defend or produce 
evidence that a schema is true. If the patient is unable 
to meet the challenge, the faulty nature of that schema 
is exposed. 

Biofeedback is a patient-guided treatment that is 
also associated with behavioral therapy. Biofeedback 
teaches an individual to control muscle tension, pain, 
body temperature, brain waves, and other bodily func- 
tions and processes through relaxation, visualization, 
and other techniques. In some cases, positive reinforce- 
ments are used to reward patients who generate the cor- 
rect biofeedback response during treatment. The name 
biofeedback refers to the biological signals that are fed 
back to the patient in order for the patient to develop 
techniques of controlling them. 


Behavioral therapy 

Behavioral therapy 


Cognitive-behavioral therapy — An offshoot of be- 
havioral therapy that focuses on changing mal- 
adaptive behaviors by changing the faulty thinking 
patterns behind them. 

Cognitive restructuring — A technique used in 
cognitive-behavioral therapy. The process of re- 
placing maladaptive thought patterns with con- 
structive thoughts and beliefs. 

Maladaptive — Unsuitable; maladaptive behavior is 
behavior that is inappropriate to a given situation. 

Psychodynamic therapy — A therapeutic approach 
that assumes improper or unwanted behavior is 
caused by unconscious, internal conflicts and fo- 
cuses on gaining insight into these motivations. 

Relapse — A return of behaviors or symptoms after 
initial treatment. 

Schemas — Fundamental core beliefs or assump- 
tions that are part of the perceptual filter people 
view the world through. Cognitive-behavioral 
therapy seeks to change maladaptive schemas. 


Patients may seek therapy independently, or be referred 
for treatment by a primary physician, psychologist, psychia- 
trist, or other healthcare professional. Because the patient 
and therapist work closely together to achieve specific thera- 
peutic objectives, it is important that their working relation- 
ship be comfortable and that their treatment goals are com- 
patible. Prior to beginning treatment, the patient and thera- 
pist should meet for a consultation session, or mutual inter- 
view. The consultation gives the therapist the opportunity to 
make an initial assessment (a detailed behavioral analysis of 
the particular incidents which lead up to and ensue after a 
specific unwanted behavior) of the patient and recommend a 
course of treatment and goals for therapy. It also gives the 
patient an opportunity to find out important details about the 
therapist’s approach to treatment, professional credentials, 
and any other relevant issues important to them. 

In some managed-care clinical settings, an intake in- 
terview or evaluation is required before a patient begins 
therapy. The intake interview is used to evaluate the pa- 
tient and assign him or her to a therapist. It may be con- 
ducted by a psychiatric nurse, counselor, or social worker. 


Behavioral therapy may not be suitable for some 
patients. Those who don’t have a specific behavioral 


issue they wish to address and whose goals for thera- 
py are to gain insight into the past may be better 
served by psychodynamic therapy. Patients must also 
be willing to take a very active role in the treatment 

Behavioral therapy may also be inappropriate for 
cognitively-impaired individuals (e.g., patients with or- 
ganic brain disease or a traumatic brain injury) depend- 
ing on their level of functioning. 

Because of the brief nature of behavioral therapy, re- 
lapse has been reported in some patient populations. 
However, follow-up sessions can frequently put patients 
back on track to recovery. 

Research & general acceptance 

The use of behavioral modification techniques to 
treat an array of mental health problems have been ex- 
tensively described and studied in medical literature. 
There may be some debate among mental health pro- 
fessionals as to whether behavioral therapy should be 
considered a first line treatment for some mental ill- 
nesses, and to what degree other treatments such as 
medication should be employed as an adjunct, or com- 
plementary, therapy. However, the general consensus 
seems to be that behavioral therapy techniques can be a 
powerful treatment tool for helping patients change un- 
desirable behaviors. 

Training & certification 

Behavioral therapists are typically psychologists 
(Ph.D., Psy.D., Ed.D., or M.A. degree), clinical social 
workers (M.S.W., D.S.W., or L.S.W. degree), counselors 
(M.A. or M.S. degree), or psychiatrists (M.D. with spe- 
cialization in psychiatry). Other healthcare providers 
may suggest brief behavioral interventions, but more ex- 
tensive treatment should be left to individuals who are 
trained in behavioral therapy techniques. 



Mills, John. Control: A History of Behavioral Psychology. New 
York: New York University Press, 1998. 


Gelder, M.“The Future of Behavior Therapy.” Journal of Psy- 
chotherapy Practice. 6, no. 4 (Fall 1997):285-93. 


The National Association of Cognitive-Behavioral Therapists. 
P.O. Box 2195, Weirton, WV 26062. (800)853-1135. 

Paula Ford-Martin 




Belladonna, more commonly known as deadly night- 
shade, Atropa belladonna , devil’s cherries, devil’s herb, 
divale, dwale, dwayberry, great morel, naughty man’s 
cherries, and poison black cherry, is a perennial herb that 
has been valued for its medicinal properties for over five 
centuries. Belladonna is a member of the Solanaceae 
(nightshade) family, and can be identified by its bell- 
shaped, purple flowers and cherry-sized green berries that 
mature to a dark purple or black color. The tall, branching 
plant can grow to a height of at least 5 ft (1.5 m), and is 
native to Europe, North Africa, and Asia and cultivated in 
North America and the United Kingdom. Belladonna has 
also been introduced to a number of places, including the 
United States and Ireland and now grows wild. 

Belladonna leaves are large (up to 10 in [25.4 cm] in 
length) and grow in pairs on either side of the plant stem. 
Near the flowers or blossoms, one of each leaf pair is no- 
ticeably smaller in size. Both the leaves and root have a 
sharp, unpleasant odor and bitter taste. As the name 
deadly nightshade suggests, the herb is highly toxic if 
taken even when taken in extremely low concentrations. 

One of the first widespread uses of the herb was 
purely a cosmetic one. Sixteenth century Italian women 
reportedly applied belladonna solutions to their eyes to 
dilate the pupils and achieve a dreamy and supposedly 
more desirable appearance (hence the name belladonna, 
which is Italian for ‘beautiful lady’). Atropine, an alka- 
loid of belladonna that blocks certain nerve impulses, is 
still used by some opthamologists today to dilate the 
pupils for eye exams. 

General use 

Belladonna has a long history of medicinal applica- 
tions in healthcare. Belladonna alkaloids are anticholin- 
ergic, which means that it works by blocking the certain 
nerve impulses involved in the parasympathetic nervous 
system, which regulates certain involuntary bodily func- 
tions or reflexes, including pupil dilation, heart rate, se- 
cretion of glands and organs, and the constriction of the 
bronchioles in the lungs and the alimentary canal (diges- 
tive tract). Belladonna relaxes the smooth muscles of the 
internal organs and inhibits or dries up secretions (e.g., 
perspiration, mucous, breast milk, and saliva). 

Belladonna alkaloids, the active ingredients of the 
plant, include atropine and scopolamine. These alkaloids 
are extracted from the leaves and root of the plant and 
administered either alone or in combination with other 
herbal remedies or prescription medications. However 


Belladonna plant. (Photo Researchers, Inc. Reproduced by 

even tiny doses are toxic and should only be taken by 


Belladonna alkaloids are used to treat a variety of 

symptoms and conditions, including: 

• Gastrointestinal disorders. Because the alkaloids relax 
the smooth muscles of the gastrointestinal tract and re- 
duces stomach acid secretions, it is useful in treating 
colitis, diverticulitis, irritable bowel syndrome, colic, 
diarrhea, and peptic ulcer. 

• Asthma. By relaxing the bronchioles, belladonna alle- 
viates the wheezing symptoms of an asthma attack. 

• Excessive sweating. Belladonna slows gland and organ 
secretion, which makes it useful in controlling condi- 
tions that cause excessive sweating. 

• Nighttime incontinence. Belladonna acts as a diuretic, 
and can be helpful in treating excessive nighttime uri- 
nation and incontinence. 

• Headaches and migraines. The pain-relieving proper- 
ties of atropine, a belladonna alkaloid, are useful in 
treating headaches. 

• Muscle pains and spasms. Belladonna is frequently 
prescribed to ease severe menstrual cramps. 




• Motion sickness. Scopolamine, an alkaloid of bel- 
ladonna, is helpful in treating motion sickness and ver- 

• Parkinson’s disease. Belladonna can alleviate the exces- 
sive sweating and salivation associated with the disease, 
as well as controlling tremors and muscle rigidity. 

• Biliary colic. Muscle spasm, or colic, of the gallbladder 
and liver can be relieved through the muscle relaxing 
properties of belladonna. 

Homeopathic use 

Belladonna is frequently prescribed homeopathic 
remedy used to treat illnesses that manifest symptoms 
similar to those that belladonna poisoning triggers (i.e., 
high fever, nausea, delirium, muscle spasms, flushed 
skin, dilated pupils). These include the common cold, 
otitis media (earache), fever, arthritis, menstrual cramps, 
diverticulitis, muscle pain, sunstroke, toothache and 
teething, conjunctivitis, headaches, sore throat, and 
boils and abscesses. As with all homeopathic remedies, 
the prescription of belladonna depends on the individ- 
ual’s overall symptom picture, mood, and temperament. 
When used as a homeopathic remedy, belladonna is ad- 
ministered in a highly diluted form to trigger the body’s 
natural healing response without risk of belladonna poi- 
soning or death. 

Results of a clinical trial performed at the National 
Cancer Institute of Milan, Italy, have also indicated that 
homeopathic remedies of belladonna can be useful in re- 
lieving the discomfort, warmth, and swelling of the skin 
associated with radiotherapy for breast cancer (i.e., ra- 


Belladonna leaf is harvested between May and July 
and dried at temperatures no warmer than 140°F (60° C). 
The roots of Atropa belladonna plants that have reached 
two to four year old maturity are also harvested for 
herbal preparations in early fall between mid-October 
and mid-November. The roots are then cleaned and dried 
at temperatures no warmer than 122°F (50°C). After dry- 
ing, the leaves and roots are crushed for use in a number 
of forms, including decoctions, tinctures, infusions, plas- 
ters, pills, suppositories, liquid solutions or suspensions, 
and powders. They can be used both alone and in combi- 
nation with other herbs and medications. 

It is extremely dangerous to self-prescribe bel- 
ladonna, and it should always be taken under the di- 
rection of a doctor or other qualified healthcare pro- 
fessional. The frequency and quantity of dosage will 
depend on both the patient and the illness the herb is 


prescribed for, but the doses are always extremely 
small. For example the Physicians Desk Reference 
(PDR) for Herbal Medicines recommends an average 
single dose of 0.05-0.10 g. Each patient’s illness is 
different and some patients experience toxicity at un- 
usually low doses. 

For homeopathic remedies, the plant is broken apart 
and juice is extracted through a pressing process. The ex- 
tract is then mixed with a water/alcohol solution by a 
ratio of either 1:10 or 1:100, and this process is repeated 
up to 30 times to form an extremely diluted dose of the 
extract. Homeopathic belladonna remedy is generally 
added to pellets of sugar for easier administration. The 
dilution and dosage frequency depend on the symptoms 
being treated, but homeopathic remedies are typically 
administered only until the patient starts to show signs of 
improvement so that the body’s natural healing response 
can take over. 

Belladonna is available by prescription both alone 
(in high concentration strength) and in combination 
with other drugs. Currently available prescription 
combinations include belladonna with opium (for 
uterine pain), kaolin and pectin (for diarrhea), pheno- 
barbital (for menopausal symptoms and migraine pro- 
phylactic), other barbiturates (for insomnia and for 
cramping and muscle spasms in the digestive tract), or 
belladonna and opium suppositories (for severe in- 
testinal cramping). 

Belladonna preparations should be stored in air-tight 
containers away from direct light. Under these condi- 
tions, most preparations will remain potent for up to 
three years. 


Ingestion of high concentrations of atropine, a po- 
tent alkaloid found in belladonna, can cause severe ill- 
ness and death. Atropine is fatal in doses as small as 100 
mg, which equals 5-50 g of belladonna herb, depending 
on the potency of the particular plant. For children, a 
fatal dose is even significantly less. For this reason, bel- 
ladonna should never be used unless prescribed by a 
trained practitioner. 

Individuals suffering from kidney disease, intestinal 
blockage, glaucoma, enlarged prostate, urinary block- 
age, severe ulcerative colitis, or myasthenia gravis are 
advised not to take belladonna, as are those patients with 
a known allergy to belladonna. Patients with any chronic 
health conditions should never take belladonna without a 
doctor’s prescription. 

Pregnant or breastfeeding women should avoid all but 
homeopathic belladonna, unless prescribed by a doctor. 


Because of the sedative qualities of belladonna, in- 
dividuals taking the herb should use caution when dri- 
ving or operating machinery. Alcohol and other central 
nervous system (CNS) depressants should also be avoid- 
ed, as they may increase drowsiness and dizziness in the 
patient taking belladonna. 

If individuals taking homeopathic dilutions of bel- 
ladonna experience worsening of their symptoms 
(known as a homeopathic aggravation), they should con- 
tact their healthcare professional. A homeopathic aggra- 
vation can be an early indication that a remedy is work- 
ing properly, but it can also be a sign that a different 
remedy is called for. 

Side effects 

Toxic signs of belladonna include dry mouth, 
drowsiness, dizziness, constipation, and nausea. Some 
side effects, including pupil dilation, blurred vision, 
fever (due to the inability to perspire), inability to uri- 
nate, arrhythmia, and excessive dry mouth and eyes, can 
also be early indications of belladonna overdose. Indi- 
viduals experiencing these side effects should inform 
their health care practitioner immediately. 

Belladonna overdose is also indicated by a burning 
throat, delirium, restlessness and mania, hallucinations, 
difficulty breathing, and flushed skin that is hot and dry. 
Without proper treatment, constriction of the airway can 
cause suffocation. If any of these symptoms occur, indi- 
viduals should seek emergency medical attention imme- 
diately. Treatment of belladonna overdose is typically 
gastric lavage, which involves inserting a tube down the 
patient’s throat and washing out the stomach with a solu- 
tion of activated charcoal or tannic acid to neutralize 
the atropine. Oxygen may also be required until breath- 
ing is stabilized, and barbiturates may be administered to 
counteract mania and/or excitation. 


Certain medications may increase the effects of bel- 
ladonna. These include central nervous system (CNS) 
depressants, monoamine oxidase (MAO) inhibitors, tri- 
cyclic antidepressants, quinidine, amantadine, antihista- 
mines, and other anticholinergics. Other medications, 
including anticoagulants (blood thinners) and corti- 
cotropin (ACTH), become less effective when used with 
belladonna, while some drugs, such as diarrhea medi- 
cines containing kaolin and attapulgite, may decrease 
the therapeutic response to belladonna when they are 
taken with the herb. If you are taking these or any other 
medications or herbal remedies, let your healthcare pro- 
fessional know. 



Alkaloids — A chemical family that contains nitro- 

Allopathic — Healthcare practice that uses reme- 
dies and treatments that cause different effects 
than the symptoms they are intended to treat; con- 
ventional medicine is usually considered allopath- 
ic in nature. 

Anticholinergic — A medication or other sub- 
stance which blocks certain parasympathetic 
nerve impulses. 

Decoction — An herbal extract produced by mix- 
ing an herb in cold water, bringing the mixture to 
a boil, and letting it simmer to extract water. The 
decoction is then strained and drunk hot or cold. 
Decoctions are usually chosen over infusion when 
the botanical in question is a root or bark. 
Homeopathic — Remedies and treatments that 
cause similar effects to the symptoms they are in- 
tended to treat in an effort to stimulate the bodies 
natural immune response system. 

Infusion — An herbal preparation made by pouring 
boiling water over an herb and letting the brew 
steep for 20 minutes, then straining. Tea is made 
through infusion. 

Mania — Hyperelevated, or excessively excited mood. 

Naturalized — Plants which are introduced in the 

Prophylactic — A preventative treatment. 

Radiodermatitis — Red, irritated, and inflamed 
skin caused by x-rays, radiation treatment, or 
other radiation exposure. 

Tinctures — An alcohol liquid extract of an herb. 

USP — The U.S. Pharmacopoeia. Nationally and 
internationally recognized drug standards pub- 
lished by the United States Pharmacopeia Con- 
vention, Inc. and used as a standard by FDA and 
other federal regulatory agencies. 

Alcohol, a CNS depressant, can also enhance the 
sedative effect of belladonna, and should be avoided dur- 
ing belladonna treatment. 

Individuals considering treatment with homeopathic 
dilutions of belladonna should consult their healthcare 
professional about possible interactions with certain 
foods, beverages, prescription medications, aromatic 
compounds, and other environmental elements that could 
counteract the efficacy of belladonna treatment. 



Beta carotene 



Jonas, Wayne B., M.D. and Jennifer Jacobs, M.D., M.P.H. 
Healing With Homeopathy. New York: Warner Books, 

Medical Economics Company. PDR for Herbal Medicines. 
Montvale, NJ: Medical Economics Company, 1998. 


Balzarini, A. et al. “Efficacy of homeopathic treatment of skin 
reactions during radiotherapy for breast cancer: a ran- 
domised, double-blind clinical trial ”, British Homeopath- 
ic Journal. (January 2000) 89(1): 8-12. 

Sahelian, Ray and Victoria Dolby Toews. “Give Colds the 
Shoulder.” Better Nutrition. (October 1999) 61(10): 40- 


The American Botanical Council. P.O. Box 144345, Austin, 
TX 78714-4345. (512)926-4900. http://www.herbalgram. 

Office of Dietary Supplements. National Institutes of Health. 
Building 31, Room 1B25, 31 Center Drive, MSC 2086, 
Bethesda, Maryland 20892-2086. (301) 435-2920. Ods@ 

Paula Ford-Martin 

Benign prostatic hypertrophy see Prostate 

Bernard training see Auditory integration 

Beta carotene 


Beta carotene is one of the most important naturally 
occurring antioxidants. It is a fat-soluble pigment found 
in plants (notably carrots and many colorful vegetables 
and fruits) and in the sea alga Dunaleilla salina and D. 
bardawil. Naturalbeta carotene supplements are derived 
primarily from D. salina. Beta carotene is one of the 
major dietary carotenoids and one of the most biological- 
ly active of approximately 800 carotenes and more than 
1 ,000 carotenoids present in food. It is responsible for the 
orange or yellow colors of many fruits and vegetables. In 
the human body, beta carotene is found in lipids and in fat 
tissues. Sometimes beta carotene is called provitamin A 
because it is more easily converted to vitamin A (retinol) 
in the liver than other carotenoids. Beta carotene is consid- 
ered to be a conditionally essential nutrient because it be- 
comes essential when vitamin A intake is low. 


Beta carotene consists of a chain of 40 carbon 
atoms, with conjugated double bonds and a ring struc- 
ture at each end of the chain. Depending on the positions 
of the molecular groups attached to the carbon chain, 
naturally occurring beta carotene may be: 

• All -trans beta-carotene 

• 9 -cis beta-carotene 

• 13-cis beta-carotene, in smaller amounts 

Synthetic beta carotene is primarily all -trans. 

In plants and alga, beta carotene and other caroten- 
oids attract light for photosynthesis and provide protec- 
tion from toxic forms of oxygen. Beta carotene is a pow- 
erful antioxidant because it destroys toxic free radicals, 
including singlet oxygen — an oxygen atom that is miss- 
ing an electron and is very damaging to human tissue if 
not taken up quickly and “deactivated.” 

General use 

Vitamin A precursor 

Vitamin A is obtained in the diet from animal prod- 
ucts or is made in the liver from beta carotene and other 
carotenoids. Vitamin A is essential for: 

• vision and eye health 

• normal cell division 

• growth 

• reproduction and fertility 

• immune system function 

• skin and mucous membrane health 

In sub-Saharan Africa about three million children 
under the age of five suffer from an eye disorder, caused 
by vitamin-A deficiency, that can lead to blindness and 
death. Although red palm oil, a traditional African food, 
contains high provitamin A, its substitution by imported 
cooking oils has reduced this dietary source in many 
homes. Many vegetables and fruits also contain provita- 
min A, but are not always consumed in adequate 
amounts. Vitamin A deficiency is the leading cause of 
blindness worldwide. 

In the 1920s vitamin-A deficiency was linked to 
stomach cancer and to precancerous conditions in the 
epithelial (lining) cells of the throat and lungs. In 1977 
vitamin A supplementation was shown to inhibit certain 
cancers and to reduce the growth of certain tumors in at- 
risk animals. 

Dietary beta carotene 

Carotenoids, including beta carotene, that are ob- 
tained from food may have: 



Serving International Units (IU) 

Daily Allowance (DA) 


1 whole raw, 7.5 in (1 9 cm) 


41 0% 


sliced and boiled, 0.5 cup (1 1 8 ml) 



Carrot juice 

canned, 0.5 cup (1 1 8 ml) 




frozed and boiled, 0.5 cup (1 1 8 ml) 


1 50% 

Sweet potatoes 

canned and drained, 0.5 cup (1 1 8 ml) 




sliced raw, 0.5 cup (1 1 8 ml) 



Vegetable soup 

canned, ready-to-serve, 1 cup (237 ml) 


1 1 5% 


raw, 1 cup (237 ml) 


1 00% 


frozen and boiled, 0.5 cup (1 1 8 ml) 




raw, 1 cup (237 ml) 



Apricot nectar 

canned, 0.5 cup (1 1 8 ml) 




1 packet instant plain 



Tomato juice 

canned, 6 oz (1 77 ml) 




2 halves with skin packed in juice 



Red pepper 

1 raw ring, 3 in (7.8 cm); 0.25 in (0.64 cm) thick 




frozen and boiled, 0.5 cup (1 1 8 ml) 




1 medium raw fruit 




canned halves or slices in water, 1 cup (237 ml) 




raw cubes, 1 cup (237 ml) 



• antioxidant activity 

• immune-system-enhancing activity 

• activity against some cancers and precancerous conditions 

• a role in preventing coronary heart disease, including 
heart attack and stroke 

Epidemiological studies that looked at cancer rates 
and diet found that at least five daily servings of green, 
orange, red, and yellow vegetables and fruits appeared to 
significantly reduce the risk of stomach, lung, prostate, 
breast, head, and neck cancer, and possibly slow the pro- 
gression of others .In 1971 a large human study linked 
cancer death rates to low levels of beta carotene in the 
blood. Subsequent studies linked high blood levels of di- 
etary beta carotene to lower cancer risks. However more 
recent evidence links these results to a combination of 
antioxidants found in fruits and vegetables, rather then to 
beta carotene alone. High beta carotene levels in the 
blood may be associated with a reduced risk of asthma. 

Supplemental beta carotene 

Supplemental beta carotene has been claimed to: 


• inhibit precancerous lesions in those at risk of oral cancer 

• protect against gastric and esophageal cancers 

• reduce the risk of prostate cancer 

• lower the overall cancer risk 

• protect against sunburn 

However, there is very little evidence that supple- 
mental beta carotene is an effective cancer-preventing 
substance, except perhaps in those with poor nutrition 
or low baseline levels of beta carotene in the blood. Ad- 
ditional studies have shown that beta-carotene supple- 
ments do not reduce the risk of cancer, heart disease, or 

Yet supplemental beta carotene does appear to in- 
crease the amounts of some types of immune-system 
cells. Studies have shown that women with low dietary 
intake or low blood levels of beta carotene are at in- 
creased risk for cervical dysplasia (abnormal cell 
growth) and cervical cancer. Another study found that 
beta-carotene supplementation provided some protection 
against the recurrence of colorectal adenoma (benign tu- 


Beta carotene 

Beta carotene 

mors) in patients who neither smoked nor drank alcohol. 
However in patients who used tobacco and/or alcohol the 
risk of recurrence increased with beta-carotene supple- 
mentation. Studies of smokers and/or those who had 
been exposed to asbestos initially found an increase in 
lung cancers among those receiving supplemental beta 
carotene (at least 20 mg per day), particularly among 
those who also consumed large quantities of alcohol. 
However follow-up studies found no such increases in 
lung cancer in those taking beta carotene. 

The Age-Related Eye Disease Study found that a 
combined supplement of beta carotene, vitamin C, vita- 
min E, zinc, and copper reduced the risk of disease pro- 
gression and vision loss in people with advanced macular 
degeneration. The supplement did not slow disease pro- 
gression in those with early-stage macular degeneration. 

One study found that supplementation with a mixture 
of antioxidants — beta carotene, alpha-tocopherol, and 
plant sterols — lowered cholesterol levels in the blood. 

Beta carotene at 25,000 international units (IU) 
daily may be useful for treating psoriasis, a skin condi- 
tion. Beta carotene supplements also are used to treat 
acne. Two 25,000-IU supplements daily, in combination 
with other supplements, sometimes are used to treat 
stomach ulcers. 


Measuring beta carotene 

A recommended dietary allowance (RDA) for beta 
carotene has not been established and most foods are not 
labeled as to vitamin A content. There are two incompat- 
ible systems for quantifying beta carotene. lUs are used 
most often for nutritional labeling: 

• 1 IU equals 0.6 pg of all -trans beta carotene 

• 3.33 IU of all-trans beta carotene, 2 jug, is equal to 1 pg 
of all -trans retinol (vitamin A) 

• 5,000 IU equals 3 mg of beta carotene, the RDA for vi- 
tamin A 

• 1 IU equals 1 .2 pg of other provitamin A carotenoids 

The second system uses retinol equivalents (RE): 

• 1 RE equals 1 pg of all -trans retinol 

• 1 RE equals 6 pg of all -trans beta carotene 

• 1 RE equals 12 pg of other provitamin A carotenoids 

Dietary beta carotene 

Daily values (DVs) are determined from the RDA. 
They are based on a 2,000-calorie diet and usually are 
expressed as a percentage of an RDA. The IUs and DVs 


for beta carotene, per serving, in common foods are list- 
ed in table 1 . 

Carrots and sweet potatoes that are more orange 
contain more beta carotene. New carrot cultivars that 
contain more beta carotene have been developed and 
high-beta-carotene sweet potatoes are being introduced 
into sub-Saharan Africa to treat vitamin-A deficiency. 

Other foods that contain beta carotene include: 

• avocados 

• broccoli 

• chard 

• coffee 

• collard greens 

• palm oil and other food colorants 

• squash 

• string beans 

• watermelon 

• yams 

According to the Institute of Medicine, a daily in- 
take of 3-6 mg of beta carotene will keep the blood level 
within the range associated with a lower risk for chronic 
diseases. The recommended daily diet of five or more 
servings of fruits and vegetables provides 3-6 mg of beta 
carotene (if carrots, sweet potatoes, papaya, apricots or 
other very high carotenoid food is used, the RDA can be 
met in a single serving). In contrast, the average Ameri- 
can diet contains 1.3-2. 9 mg daily. Vegetarians may have 
twice as much beta carotene in their blood as compared 
to non- vegetarians, because they generally consume a lot 
more greens and fruits. 

Beta carotene in food is found within an oil or a ma- 
trix of sugars and proteins; and, therefore, the absorption of 
beta carotene by the body varies greatly. The elderly, and 
those with bad digestion and liver trouble may be at risk 
for poor absorption from an adequate beta carotene diet. 

Animal sources of vitamin A are more easily ab- 
sorbed than plant sources of beta carotene, particularly if 
the vegetables and fruits are eaten raw or whole. Al- 
though beta carotene can be converted to vitamin A in 
the body, it has its own unique physiological functions 
and beta carotene and vitamin A are not totally identical 
in the health benefits they deliver. So it is good to eat 
sources of both. While supplementation is helpful to 
those who have trouble absorbing adequate beta 
carotene, getting all or some beta carotene through food 
sources rather than supplements alone is by far the best. 
This is substantiated by research showing there are many 
beneficial carotenoids in foods, and that they may also 
work together synergistically to optimize health. 


Supplemental beta carotene 

Beta carotene supplements are inexpensive and 
readily available over-the-counter. They are available as 
pills, powders, and oils and they vary greatly in potency. 
Some supplements contain a mixture of carotenoids. 
There is a major problem with shelf life stability for beta 
carotene, as it “oxidizes” quickly when in pure form. 
When buying a supplement of it, shelf life stability or the 
presence of such stabalizers as vitamin E can guarantee 
biological activity of the capsule. 

Supplemental intake of beta carotene probably 
should not exceed 3-15 mg per day. Common prepara- 
tion of supplemental beta carotene include: 

• 30- or 60-mg capsules 

• 5,000-, 10,000-, or 25,000-IU capsules 

• 10,000- or 25,000-IU tablets 

A typical dosage of beta carotene for treating cancer 
is 75,000-150,000 IU daily. Absorption of beta carotene 
in nutritional supplements can be 70% or more. There is 
no established maximum daily intake for beta carotene. 

Some common beta carotene nutritional supple- 
ments include: 

• A-Caro-25 

• B-Caro-T 

• Biotene 

• Caroguard 

• Caro-Plete 

• Dry Beta Carotene 

• Lumitene 

• Marine Carotene 

• Mega Carotene 

• Oceanic Beta Carotene 

• Superbeta Carotene 

• Ultra Beta Carotene 

Manufacturers often supplement food with beta 
carotene. One study showed that bakery products en- 
riched with beta carotene increased beta carotene levels 
in the blood. 


Antioxidants such as beta carotene often work to- 
gether with other antioxidants and an excess or deficien- 
cy of one can inhibit the other. The Food and Nutrition 
Board of the Institute of Medicine does not recommend 
beta carotene supplementation except in cases of vitamin 
A deficiency. 


Pregnant and nursing mothers should limit their in- 
take of supplemental beta carotene to 6 mg per day or less. 

Side effects 

Even long-term high-dosage use of supplemental 
beta carotene appears to be non-toxic. Daily doses of 30 
mg or more over a long period may cause carotenosis 
(carotenodermia), a yellowing of the skin, which is 
harmless and reversible. In contrast, very high daily 
doses of vitamin A are very dangerous and damage the 
liver and other organs, as well as provoke hair loss). 


Drugs and other substances that may interfere with 
beta-carotene absorption include: 

• Cholestyramine 

• Colestipol 

• mineral oil 

• Olestra 

• Orlistat 

• pectin 

The absorption of luteine, another carotenoid an- 
tioxidant, may be reduced if taken in conjunction with 
beta carotene. 



American Institute for Cancer Research. Nutrition and Cancer 
Prevention: New Insights into the Role of Phytochemicals. 
New York: Kluwer Academic/Plenum Publishers, 2001. 
Dietary Reference Intakes for Vitamin C, Vitamin E, Selenium, 
and Carotenoids. Washington: National Academy Press, 
2000 . 

PDR for Nutritional Supplements. Montvale, NJ: Thomson 
PDR, 2001. 


Baron, J. A., et al. “Neoplastic and Antineoplastic Effects of 
Beta-Carotene on Colorectal Adenoma Recurrence: Re- 
sults of a Randomized Trial.” Journal of the National 
Cancer Institute 95 (2003): 717-22. 

Bendich, Adrianne. “From 1989 to 2001: What Have We Learned 
about the "Biological Actions of Beta-carotene?’” Journal of 
Nutrition 134, no. 1 (January 2004): 125S-130S. 
“Disheartening Study.” Better Nutrition 65, no. 9 (September 
2003): 32. 

Heinrich, U., et al. “Supplementation with Beta-carotene or a 
Similar Amount of Mixed Carotenoids Protects Humans 
from UV-induced Erythema.” Alternative Medicine Re- 
view 8, no. 2 (May 2003): 202-203. 

"Incidence and Mortality Following Alpha-tocopherol and 
Beta-carotene Supplementation: A Postintervention Fol- 


Beta carotene 

Beta hydroxy 


Alpha-tocopherol — An antioxidant derivative of 
vitamin E that stabilizes cell membranes. 

Antioxidant — A substance that prevents oxidation, 
such as cellular damage caused by free radicals. 

Carotenoid — A large class of red and yellow pig- 
ments found in some plants and in animal fat. 

Carotenosis (carotenodermia, carotenemia) — A 

yellowish pigmentation of the skin caused by high 
levels of carotene in the blood. 

Cholesterol — An important sterol that is deposited 
on blood vessel walls in arteriolosclerosis. 

Daily value (DV) — The percentage of the RDA of a 
nutrient that is present in a food or supplement. 
Epithelium — Layers of cells covering internal and 
external body surfaces. 

Free radical — An atom or compound with an un- 
paired electron; oxygen free radicals can damage 
cells and cell constituents. 

Immune system — The body system that protects 
against foreign pathogens and abnormal cells. 

International unit (IU) — A widely accepted defin- 
ition that is used to quantify a given substance. 
Macular degeneratio. — The progressive deteriora- 
tion of the macula — the light-sensitive cells of the 
central retina of the eye. 

Provitamin A — A carotenoid, such as beta 
carotene, that can be converted into vitamin A in 
the liver. 

Recommended dietary allowance (RDA) — The av- 
erage daily dietary intake of a nutrient that is suffi- 
cient to meet the nutritional requirements of 
97-98% of healthy individuals of a given age and 

Retinol equivalent (RE) — 1 pg of all -trans retinol 
(vitamin A), 6 pg of all -trans beta carotene. 
Vitamin A (retinol). — An essential nutrient for vi- 
sion that is obtained from animal products or 
made in the liver from carotenoids such as beta 

low-up.” Journal of the American Medical Association 
290. no. 4 (July 23, 2003): 476-85. 

Quilez, Joan, et al. ‘‘Bakery Products Enriched with Phytos- 
terol esters, [Alpha] -Tocopherol and [Beta]-Carotene De- 
crease Plasma LDL-Cholesterol and Maintain Plasma 
[Beta]-Carotene Concentrations in Normocholesterolemic 


Men and Women.” Journal of Nutrition 133. no. 10 (Octo- 
ber 2003): 3103. 

Russell, R. M., et al. “The Enigma of Beta-Carotene in Car- 
cinogenesis: What Can Be Learned From Animal Stud- 
ies.” Journal of Nutrition 134, no. 1 (2004): 262S-268S. 

“What’s Up Doc? Getting to the Root of Carrots.” Environmen- 
tal Nutrition 26, no. 9 (September 2003): 8. 

“The Word: Sweet Potato.” New Scientist 179, no. 2402 (July 
5, 2003): 51. 


“Beta Carotene.” Making Treatment Decisions. American Cancer 
Society. 2000 [cited May 4, 2004]. <http://www.cancer. 

Beta Carotene. Mayo Clinic. May 10, 2002 [cited May 4, 
2004], < 

Task Force Finds Little Evidence to Support Use of Vitamin 
Supplements to Prevent Cancer or Heart Disease. Agency 
for Healthcare Research and Quality. June 30, 2003 [cited 
May 4, 2004]. < 

Vitamin A and Carotenoids. Office of Dietary Supplements, 
National Institutes of Health. October 6, 2003 [cited May 
4, 2004], < 

Margaret Alic 

Beta hydroxy 


Beta hydroxy acids are a group of acids whose skin 
treatment properties are being rediscovered. Developed 
long ago for acne treatment, salicylic acid, benzoic acid, 
butyric acid and other less well known acids have been 
recently reclassified as beta hydroxy acids (BHAs) or 
beta hydroxys. 

BHAs are exfoliants, which means that they cause 
the top layers of the skin to exfoliate or peel. Exfoliation 
leaves behind fresh skin that is also smoother and softer 
than before. Beta hydroxys work by speeding up the 
turnover of skin cells. They dissolve the glue that holds 
dead skin cells in the top layers, allowing the fresh cells 
beneath to emerge. Chemical exfoliation with beta hy- 
droxys peels away a variety of such age-related skin 
problems as wrinkles, acne, age spots, blemishes, and 
skin unevenness. Used on a regular basis at a much 
lower concentration as cleansers or acne treatments, 
BHAs refresh the skin and clear away the dirt and oils 
that often cause acne eruptions. In addition to cosmetic 


applications, these chemicals also are used as treatments 
for a variety of skin disorders, including psoriasis, seb- 
orrhea, dandruff, and warts. 

BHAs are found in many skin care products. They 
are also found naturally in fresh fruit (berries, pineapple, 
papaya, etc.), milk and yogurt, wintergreen leaves, 
sweet birch, and some other plants. 

Structurally, BHAs appear to be very similar to an- 
other group of chemicals used in skin care products, the 
alpha hydroxy acids or AHAs. These two groups of 
chemicals have similar activities as well; both are skin 
exfoliants. BHAs, however, are believed to be less irritat- 
ing to the skin than AHAs. They are also more effective 
in preventing acne eruptions and smoothing the skin. 

General use 

Skin cleansing 

Many skin cleansers today contain BHAs. BHAs are 
effective because they help remove excess oil from the 
face. They can, however, remove oil only on the surface 
and cannot affect oil production under the skin. To help 
maintain healthy skin, these cleansers should be used once 
or twice a week to improve skin tone and texture. BHA- 
containing preparations should be left on the face for a 
short time only and rinsed off with generous amounts of 
water. Because the skin is more sensitive to sunlight after 
the use of products containing BHAs, users should apply 
sunscreens and avoid prolonged sun exposure. 

Wrinkles and age spots 

Wrinkles are signs of the normal aging process. 
Over the years, the skin becomes thinner, drier and less 
elastic as its collagen and elastin fibers gradually lose 
their elasticity. To improve the appearance of the skin 
and to correct minor blemishes and uneveness, some 
people have chemical peels with hydroxy acids. Chemi- 
cal peels have become one of the most popular methods 
for removing wrinkles. This process uses concentrated 
preparations of BHAs, AHAs, or combinations of both to 
remove the top layer of skin. The chemical peel allows a 
newer layer of skin to replace the older layer. Some fine 
lines and wrinkles may also be removed. 

Because of potential scarring and other severe ad- 
verse reactions, chemical peels are done by a profession- 
al, usually a board-certified dermatologist or a licensed 
estheticist (skin care specialist). 

For best results, chemical peels are often used in combi- 
nation with such other anti- wrinkle treatments as collagen or 
fat implants or laser surgery. For relatively young people, a 
chemical peel with BHA often provides satisfactory results. 
Those over 40 sometimes choose to have collagen or fat im- 


plants together with the peel. Some older patients may have 
both a chemical peel and a special kind of laser surgery 
called laser resurfacing. While chemical peels can remove 
some fine wrinkle lines, laser resurfacing is a more powerful 
tool. It can remove deeper wrinkles and skin imperfections. 

Acne therapy 

Acne is a skin disorder caused by excessive produc- 
tion of oil under the uppermost layers of skin. When the 
oil cannot pass through the hair follicles, the pores under 
the skin are plugged up, trapping the oil and dead skin 
cells underneath the skin. These plugged pores become 
fertile breeding grounds for a type of bacterium called 
Propionibacterium acnes, sometimes called the acne 
bacillus, to grow inside the pore, causing irritation, in- 
flammation, and in due time, pimples. 

Because it is an effective cleanser, a 1% solution of 
salicylic acid, which is a BHA, can enter the pores and 
help to remove excess oil, dirt, and dead skin cells. It re- 
duces skin breakouts by preventing the buildup of dead 
skin cells associated with acne formation. Beta hydroxy 
acids, including salicylic acid, are good treatments for 
acne because they are relatively mild. Because they are 
applied topically, they do not cause systemic side effects 
as oral antibiotics sometimes do. In addition, they are es- 
pecially appropriate for the treatment of acne because 
they have anti-inflammatory properties. BHAs, however, 
do not have the antimicrobial properties of such topical 
medications as benzyl peroxide. 


Psoriasis is a chronic skin condition requiring life- 
long treatment with topical lotions and creams, pho- 
totherapy (using radiation or ultraviolet light), or med- 
ications taken by mouth. Salicylic acid can be used to 
treat psoriasis. Salicylic acid facilitates the removal of 
scaly skin. In so doing, it helps moisturizers and other 
topical medications for psoriasis work more effectively. 


Salicylic acid is also an effective and mild treatment 
for warts and plantar warts. Patients should wash and dry 
the area around the wart thoroughly before applying the 
product. Then they should apply a thin film of salicylic acid 
over each wart and allow it to dry. The product should be 
applied once or twice a day. Salicylic acid acts slowly and 
may take as long as 12 weeks before one can see results. 

Other uses 

The anti-inflammatory properties of BHAs are use- 
ful in treating such other skin conditions as dandruff or 
seborrheic dermatitis. 


Beta hydroxy 

Beta hydroxy 


Salicylic acid is often found in many over-the- 
counter skin care products such as soaps, cleansers, acne 
medications, and anti-wrinkle creams. These products, 
however, contain only 2% of salicylic acid. This concen- 
tration is strong enough for exfoliation but not for chem- 
ical peel treatment. 

Chemical peel preparations contain very high con- 
centrations (up to 30%) of beta hydroxy acids in combi- 
nation with alpha hydroxy acids. Because of the poten- 
tial for scarring and other severe adverse reactions, these 
prescription-strength products are not sold to the general 
public. They are available only to licensed dermatolo- 
gists or estheticians. 

BHAs can also be found in certain fruits and vegeta- 
bles. For example, thin layers of papaya can be applied 
on the face and allowed to remain for a while. Papaya 
pulp helps soften the skin and decrease its unevenness. It 
is most beneficial to dry, sun-damaged skin, although it 
may also cause allergic reactions in some sensitive peo- 
ple. Pineapple is another natural product that contains 
beta hydroxy acid. Pineapple can be put into a blender or 
juicer to obtain fresh juice. The juice can be applied to 
the skin; again, however, it may cause allergic reactions. 


People who use skin care products containing BHAs 
should be aware of the following considerations and side 

• Increased sensitivity to sunlight. Exfoliated skin is very 
tender and sensitive to sunlight. Studies have shown 
that skin treated with these exfoliants has twice the sun 
damage compared to untreated skin. Therefore, it is im- 
portant to use suncreen and avoid direct exposure to the 
sun when using products containing BHAs. 

• Sensitization to other products. The use of salicylic 
acid sometimes sensitizes the skin to other cosmetics 
and causes redness and irritation. In other to avoid skin 
sensitization, it is best to use only mild cleansers and 
wait at least 10-30 minutes before using another cos- 
metic or skin care product. Another way to avoid skin 
sensitization is to use the BHA product every other day 
instead of daily. 

• Stinging. Salicylic acid can produce a stinging sensa- 
tion when first applied. That is because it is a mild skin 
irritant. Products containing salicylic acid should not 
be applied on raw or abraded skin, as they may cause 
redness and intense itching. 

•Allergic reactions. Some salicylic acid products can 
provoke hypersensitivity reactions. Any products that 



Collagen — A fibrous tissue found in bones, con- 
nective tissue, and cartilage. 

Elastin — A yellow fibrous protein that is the basic 
component of elastic connective tissue. 

Exfoliate — To remove or peel off flakes or layers of 

Plantar warts — Warts located on the sole of the 

cause skin to burn, sting, redden, or break out should be 
discontinued immediately. 

• Blotchy skin. Sometimes BHA chemical peels cause 
scarring and discoloration of some parts of the skin. 
This occurs most often with the more concentrated 
BHA products. Scarring and blotchy skin also tend to 
occur more frequently in people with darker skin. 

• Dry skin. A person with dry skin should not use BHA 
cleansers too frequently (more than once a week) be- 
cause they tend to dry the skin even further. 

• Eye irritation. Skin care products containing salicylic 
acid tend to cause the eyes to redden and water. Avoid 
applying these cleansers, cream or lotion too close to 
the eyes. 

Side effects 

Patients should stop using the product and contact 
their doctors or pharmacists for advice if the following 
adverse effects occur: 

• dry skin 

• eye irritation 

• allergic reactions 

• skin irritation 


Because salicylic acid tends to sensitize the skin, 
allow at least 10-30 minutes to elapse between the use of 
products containing salicylic acid and applying cosmet- 
ics or other skin care products. 



Sarnoff, Deborah S., and Joan Swirsky. Beauty and the Beam: 

Your Complete Guide to Cosmetic Laser Surgery. New 

York: Quality Medical Publishing Inc., 1998. 


Tourles, Stephanie. Naturally Healthy Skin: Tips and Techniques for 
a Lifetime of Radiant Skin. Vermont, RI: StoreyBooks, 1999. 


Flynn, T. C. and W. P. Coleman. “Topical revitalization of body 
skin." J Eur Acad Dermatol Venereol (July 2000): 280 — 4. 

Kligman, D. and A. M. Kligman. “Salicylic acid peels for the 
treatment of photoaging.” Dermatol Surg (March 

Kockaert, M. and M. Neumann. “Systemic and topical drugs 
for aging skin.” J Drugs Dermatol (August 2003):435-41. 


American Academy of Dermatology. P.O. Box 4014. Schaum- 
burg, IL 60168-4014. (888) 462-DERM. Fax: (847) 330- 
8907. <>. 

Samuel Uretsky, Pharm.D. 

Betaine hydrochloride 


The digestive process takes place as food passes 
through the gastrointestinal tract, which consists of the 
mouth, stomach, small intestine, and large intestine. Betaine 
hydrochloride (C 5 H 12 N0 2 C1) is a source of hydrochloric 
acid, a naturally occurring stomach acid that helps break up 
fats and proteins for further digestion in the small intestine. 
Gastric (stomach) acid also aids in the absorption of nutri- 
ents through the walls of the intestines into the blood. 

Gastric acid also helps protect the gastrointestinal 
tract from harmful bacteria. A normal level of gastric 
acid in the stomach — 100,000-1,000,000 times more 
acidic than water — is sufficient to destroy bacteria, but a 
low level increases the likelihood and severity of certain 
bacterial and parasitic intestinal infections. One study 
showed that fasting people with normal gastric acid lev- 
els in the stomach had almost no bacteria in the small in- 
testine, while individuals with low levels of hydrochloric 
acid had some bacterial colonization in the stomach. 

Betaine hydrochloride is a synthesized chemical, 
and is not obtained from any plant or animal source. 
Gastric acid is produced by stomach cells, and is not 
available from any food source. Occasionally, betaine 
(C 5 H u N0 2 )is recommended to reduce blood levels of 
homocysteine, which is associated with heart disease. 
This form of betaine is different from betaine hydrochlo- 
ride, and is available only with a doctor’s prescription. 

General use 

Some research suggests that individuals with a wide 
variety of chronic disorders, such as allergies, asthma, 


and gallstones, do not produce adequate amounts of 
stomach acid. Many people with rheumatoid arthritis 
are deficient in stomach acid and other digestive factors. 
Taking betaine hydrochloride with meals can aid in pro- 
tein digestion and possibly reduce food sensitivities 
through improved digestion. 

Naturopaths have long held that low stomach acid is 
a widespread problem that interferes with the digestion 
and absorption of nutrients. Betaine hydrochloride is one 
of the most common recommendations for this condi- 
tion. It helps make some minerals and other nutrients 
more absorbable, and may be especially helpful with nu- 
tritional supplements, which are often taken in tablets or 
capsules that may not be easily digested. 

Based on naturopathic theories about the importance 
of stomach acid, betaine hydrochloride has been recom- 
mended for a wide variety of problems, including ane- 
mia, asthma, atherosclerosis, diarrhea, excess Candida 
yeast, food allergies, gallstones, hay fever and allergies, 
inner ear infections, rheumatoid arthritis, and thyroid 
conditions. Many naturopathic physicians also believe 
that betaine hydrochloride can help conditions such as 
ulcers, indigestion, and esophageal reflux (heartburn). 
Conventional treatment for those conditions involves re- 
ducing stomach acid; according to one theory, however, 
lack of stomach acid leads to incomplete digestion of 
proteins, which causes allergic reactions and other re- 
sponses that lead to increased ulcer pain. In keeping 
with this theory, some doctors might recommend animal- 
derived pancreatic enzymes for patients experiencing al- 
lergic reactions to food. Vegetarians may wish to take be- 
taine hydrochloride as an alternative to pancreatic en- 
zymes, since it is not an animal product. Individuals suf- 
fering from allergies, ulcers, or heartburn should talk to 
their doctors before using betaine hydrochloride. 

Betaine hydrochloride may be used as a lipotropic. 
Lipotropics aid in preventing the accumulation of fat in 
the liver, and usually help in the detoxification of meta- 
bolic wastes and toxins. They may be used to help with 
weight loss. 

Benefits of lipotropics 

• Detoxification of the waste byproducts of protein syn- 

• Increasing resistance to disease by stimulating the thy- 
mus gland. 

• Stepping up production of lecithin in the liver, which 
can lower cholesterol levels. 

• Preventing plaque deposits in arteries. 

• Preventing gallstone formation. 


Betaine hydrochloride 

Beta-methylbutyric acid 

• Protecting against diabetic neuropathy, a condition in 
which the cranial and spinal nerves, as well as the 
nerves in the bladder and bowel, may be affected. 

Betaine hydrochloride has been used as a source of 
hydrochloric acid in the treatment of hypochlorhydria, a 
condition in which an abnormally low amount of hy- 
drochloric acid is in the stomach. It has been used in prepa- 
rations for the treatment of liver disorders, hypokalaemia 
(abnormally low levels of potassium in the blood), C0 2 
production in double contrast radiography, and high homo- 
cysteine. Betaine hydrochloride has also been used to treat 
tic douloreux (a condition which involves spasmodic pain 
along the course of a facial nerve), cystinuria (a hereditary 
defect that results in recurrent kidney stone formation), and 
vitiligo (a condition that is characterized by milky-white 
patches on otherwise normal skin). 


Betaine hydrochloride (also called betaine HC1) is 
typically taken in tablets or capsules of 5-10 grains (325- 
650 mg)each with a meal that contains protein. Naturo- 
pathic or nutritionally oriented physicians may make rec- 
ommendations of such tablets based on their diagnoses. 


People with a history of ulcers, heartburn, or other 
gastrointestinal symptoms should see a nutritionally ori- 
ented doctor before taking betaine hydrochloride, and no 
one should take more than 10 grains (650 mg) without a 
physician’s recommendation. Large amounts of betaine 
hydrochloride can burn the lining of the stomach. If a 
burning sensation is experienced, betaine hydrochloride 
should be immediately discontinued. 

Side effects 

Side effects are seldom seen, but betaine hydrochlo- 
ride has not been through rigorous safety studies. Its safety, 
especially for young children, pregnant or nursing women, 
or those with severe liver or kidney disease, is not known. 


People taking nonsteroidal anti-inflammatory drugs 
(NSAIDs), cortisone-like drugs, or other medications 
that could cause peptic ulcers should not take betaine hy- 



Challem, Jack. “Navigating the labyrinth: 30 things you need 

to know about nutritional supplements.” Vegetarian Times 

(January 1998), no. 245: 66-67 . 



Cystinuria — Excess cystine, lysine, arginine, and 
ornithine in urine due to defective transport sys- 
tem of these acids in kidney and intestines. 

Gastric acid — Also, stomach acid. Helps break up 
fats and proteins for further digestion, aids in the 
absorption of nutrients through the walls of the in- 
testines into the blood, and helps protect the gas- 
trointestinal tract from harmful bacteria. 
Homocysteine — An amino acid in the blood, too 
much of which is related to a higher risk of vascu- 
lar disease. 

Lipotropic — Substances that help prevent or cor- 
rect excessive fat deposits in liver. 

Gormley, James J. “Healthful weight loss includes L-carnitine, 
chromium, and lipotropics.” Better Nutrition 58, no. 5: 40- 


Personal Health Zone. “Betaine Hydrochloride.” [cited December 
2000], < 


GNC (General Nutrition Centers), [cited December 
2000]. < 
betaine_HCl-F.htm/ > 

Melissa C. McDade 

Beta-methylbutyric acid 


Beta-methylbutryic acid, technically known as, 
“beta-hydroxy beta-methylbutyric acid,” or more com- 
monly known as “HMB,” is a metabolite of the amino 
acid leucine. Human muscles have a particularly high 
concentration of leucine, so this amino acid is often bro- 
ken down/utilized during strenuous exercise. HMB is 
also found in grapefruit and catfish in trace quantities. It 
was first found to be of use in agriculture as an additive to 
help pigs, chickens, and other farm animals gain muscle 
and lose fat. It was not until a research trial conducted by 
the University of Iowa at Iowa City showed positive re- 
sults that it caught attention as promising for human use. 

The four-week double-blind study in 1995 involved 
17 exercise-trained and 23 untrained males, divided into 
two groups. One group took daily capsules containing 3 


g of HMB, and the other took placebos. Everyone ob- 
served an identical weight-training regimen three times a 
week. Upon the trial’s completion, the group who took 
the HMB demonstrated an average 3.1% increase in lean 
muscle mass, as compared with 1.9% for those who took 
the placebos. Also, the HMB group lost an average of 
7.3% initial body fat, against 2.2% for the placebo 
group. The men who took HMB were able to average 22 
pounds more with the bench press than they did at the 
beginning of the study. The men who did not, averaged a 
14 pound increase. Thus, when taken as a supplement, 
up to 3 g a day, HMB has been shown to increase lean 
muscle mass and strength in athletes who use it during 
weight training. Theories suggest that HMB possibly 
suppresses protein breakdown that follows exercise that 
is rigorous and of long-term duration. 

The patent for HMB is held jointly by Iowa State 
University and Vanderbilt University, which conducted 
the first studies on the compound. Experimental and Ap- 
plied Sciences, Inc. (EAS)of Golden, Colorado, was 
originally licensed to market it. As of 2000, dozens of 
companies have it available for sale through retail stores, 
and commercial websites. 

General use 

By the Summer Olympics in Atlanta in 1996, the 
publicity of the possible benefits of HMB had spread 
among athletes. Because it was not a banned substance, 
demand was heavy; it continues to remain popular 
among athletes as a nutritional supplement. This is true 
particularly for weight trainers, but has been reported as 
useful for any athlete undergoing resistance training. It is 
considered a “state-of-the-art” bodybuilding supplement, 
and tends to show an increase of lean mass and strength 
among those who use it. Studies have also shown that 
HMB might also accelerate fat loss that occurs sec- 
ondary to strenuous exercise. According to Wayne Hearn 
in American Medical News in August of 1996, Dr. Naji 
N. Abumrad, MD, originally with the Vanderbilt team, 
began to conduct studies in 1996 that explored HMB’s 
“potential use as an antiwasting agent that could benefit 
AIDS and cancer patients and help maintain muscle 
mass in the elderly.” This research remains as ongoing. 


HMB is available in both powder and capsule form, 
with capsule form being the primary method of usage. In 
2000, an average price for 250 mg capsules ran approxi- 
mately $35-$55 depending on retailer and volume pur- 
chased. Because HMB is a food supplement and not a 
drug, it is not subject to Federal Drug Administration 
(FDA) standards, and therefore has no minimum require - 



Leucine — An amino acid produced by the hydrol- 
ysis of proteins by pancreatic enzymes during di- 
gestion, and by putrefaction of nitrogenous organ- 
ic matter. 

ment recommendation. Tests have suggested that 
dosages from 1.5-3 g a day are required to achieve de- 
sired results. 


As a food supplement found in every cell of the 
human body, it has no toxic effects, according to the re- 
search conducted. Because no long-term studies had 
been conducted on children, or pregnant or lactating 
women, the supplement could not be recommended for 
these groups. Thus, these groups of people should con- 
sult a physician, and use HMB with caution. 

Side effects 

According to Abumrad, the only side effects discov- 
ered have been positive ones. Yet the benefits of lower 
cholesterol and blood pressure levels found to occur with 
the use of the supplement, were also associated with the 
intense exercise that seems to trigger HMB’s tissue -build- 
ing effects. As Hearn reported, “That stands in stark con- 
trast to the side effects of unprescribed steroid use by ath- 
letes and bodybuilders, which has been linked to cancer, 
heart disease, kidney and liver damage, and erratic mood 
swings.” Studies were ongoing to determine what other 
possible benefits or disadvantages HMB would prove to 
be for the long-term period of usage. Physicians were 
urged to add caution to their patients regarding this sup- 
plement to be alert to any unforeseen complications. In 
2000, various websites offer testimony for or against 
usage. Those who recommend against it do so only in of- 
fering that it did not appear to be of any use, and did not 
provide them with the touted benefits. 


No known adverse reactions have yet been docu- 
mented when HMB is taken with other drugs or food 
supplements. It has been recommended for usage with 
creatine monohydrate for intense training. 



Antonio, Jose, Ph.D. Let’s Live 66, no. 6 (1998). 


Beta-methylbutyric acid 

Bhakti yoga 

Antonio, Jose.Ph.D. Muscle & Fitness 58, no.5 (1997). 

Hearn, Wayne. American Medical News 39, no. 31 (1996). 
Available at: 

Lee, In- Young and J.P.N. Rosazza. Archives of Microbiology 
169, no. 3 (1998). Available at: http://link.springer~ny. 

Maenz, David D. and Carmen M. Engele-Schaan. Journal of 
Nutrition 126, no. 2 (1996). Available at: http://web4. 

Mulgannon, Terry. Men’s Fitness 13, no. 6 (1997). 


Burke, Edmund R.,Ph.D. News, http:// 

Jane Spear 

Bhakti yoga 


Bhakti yoga is one of six major branches of yoga, rep- 
resenting the path of self-transcending love or complete 
devotion to God or the divine. A practitioner of bhakti yoga 
regards God as present in every person or sentient being. 
Although bhakti yoga developed within a Hindu culture, it 
can be practiced by members of Western religions, as it fo- 
cuses the believer’s mind and heart on God as a supreme 
Person rather than an impersonal Absolute. Unlike hatha 
yoga, which is the form of yoga most familiar to Ameri- 
cans, bhakti yoga does not place great emphasis on breath- 
ing patterns or asanas (physical postures), but rather on 
acts of worship, devotion, and service. 


Bhakti yoga is thought by some to be the oldest 
form of yoga, with its roots in the Vedas, or ancient 
scriptures of India. Some of the hymns in the Vedas are 
thought to be four thousand years old. Bhakti yoga did 
not emerge as a distinctive form of yoga, however, until 
about 500 B.c., the time of the composition of the Bha- 
gavad-Gita, a Sanskrit work containing the teachings of 
Krishna, one of the most beloved of Hindu deities. 

Bhakti yoga eventually became the focus of a popu- 
lar devotional movement in India known as the bhakti- 
marga or “road of devotion.” This movement flourished 
between 800 and 1100 A.D.. Around 900, devotees of Kr- 
ishna who belonged to the bhakti-marga produced a 
scripture known as the Bhagav ad-Pur ana, which con- 
tains Krishna’s instructions to his worshipers. In one 
passage from the Bhagav ad-Pur ana, Krishna praises 


bhakti above all other paths to bliss. He is represented as 
saying, “The wise person should abandon bad company 
and associate with the virtuous, for the virtuous ones 
sever the mind’s attachments [to worldly concerns] by 
their utterances.. O greatly blessed devotee, these 
blessed ones constantly tell my story, by listening to 
which people are released from sin. Those who respect- 
fully listen to, esteem, and recite my story become dedi- 
cated to me and attain faith and devotion to me.” 


The chief benefit of bhakti yoga, from the perspec- 
tive of its practitioners, is greater love for and closeness 
to God, and to other people (and all beings) as reflections 
of God. Although bhakti yoga is also beneficial to mental 
and physical well-being, improved health is not the pri- 
mary reason most adherents choose this form of yoga. 


The Hindu sacred texts list nine forms of bhakti 

• Sravana. Sravana is the Sanskrit term for listening to 
poems or stories about God’s virtues and mighty deeds. 
Sravana bhakti cannot be practiced in isolation, howev- 
er; the devotee must hear the stories from a wise 
teacher, and seek the companionship of holy people. 

• Kirtana. Kirtana refers to singing or chanting God’s 
praises. Ram Dass has said of this form of bhakti 
“When you are in love with God, the very sound of the 
Name brings great joy.” 

• Smarana. Smarana is remembrance of God at all times, 
or keeping God in the forefront of one’s consciousness. 
In Christian terms, smarana is what the French monk 
Brother Lawrence (1605-1691) meant by “the practice 
of the presence of God.” 

• Padasevana. This form of bhakti yoga expresses love to- 
ward God through service to others, especially the sick. 

• Archana. Archana refers to worship of God through 
such external images as icons or religious pictures, or 
through internal visualizations. The purpose of archana 
is to purify the heart through love of God. 

• Vandana. Vandana refers to prayer and prostration 
(lying face downward on the ground with arms out- 
stretched). This form of bhakti yoga is intended to curb 
self-absorption and self-centeredness. 

• Dasya. In dasya bhakti, the devotee regards him- or 
herself as God’s slave or servant, carrying out God’s 
commandments, meditating on the words of God, car- 
ing for the sick and the poor, and helping to clean or re- 
pair sacred buildings or places. 


• Sakha-bhava. This form of bhakti yoga is a cultivation 
of friendship-love toward God — to love God as a mem- 
ber of one's family or dearest friend, and delight in 
companionship with God. 

• Atma-nivedana. Atma-nivedana is complete self-offer- 
ing or self- surrender to God. Unlike some other forms 
of yoga, however, bhakti yoga does not teach that the 
devotee completely loses his or her personal identity 
through absorption into the divine. God is regarded as 
infinitely greater than the human worshiper, even one at 
the highest levels of spiritual attainment. 

The nine types of bhakti yoga are not considered a 
hierarchy in the sense that some are regarded as superior 
to others in guiding people toward God. An Indian 
teacher of bhakti yoga has said, “A devotee can take up 
any of these paths and reach the highest state. The path 
of bhakti is the easiest of all [types of yoga] and is not 
very much against the nature of human inclinations. It 
slowly and gradually takes the individual to the Supreme 
without frustrating his [sic] human instincts.” 


The practice of bhakti yoga does not require any 
special physical or emotional preparation. It is a good 
idea, however, for Western readers to gather more in- 
formation about a specific form of bhakti yoga that 
may interest or attract them. This preparation is partic- 
ularly important because the tendency of Western cul- 
ture to separate intellect from feeling leads many peo- 
ple to think of bhakti as sheer emotional fervor that 
does not engage the mind, whereas many of the great 
teachers of bhakti yoga were known for their wisdom 
and mindfulness as well as intensity of devotion. Use- 
ful resources for learning more about bhakti yoga in- 
clude such periodicals as Yoga Journal and the various 
organizations listed below. 


Bhakti yoga tends to attract persons of a strongly 
emotional nature. There is some risk, however, of such 
individuals remaining spiritually immature or joining 
cult-like groups. The Hare Krishna movement, for exam- 
ple, is an offshoot of one school of bhakti yoga, the 
Gaudiya vaishnava tradition. Although some members of 
the movement consider their participation meaningful, 
others have left because they experienced it as repressive 
and intolerant of other faiths. 

Side effects 

There are no known side effects associated with the 
practice of bhakti yoga. 


Research & general acceptance 

A number of research studies have shown that such 
spiritual and devotional practices as those associated 
with bhakti yoga have positive effects on physical as 
well as emotional health. The positive physical effects 
include strengthening of the immune system, lowered 
blood pressure, and improved ability to cope with chron- 
ic pain. Chanting or hymn singing (kirtana) has been 
shown to be particularly effective in pain management. 

Several research studies published in early 2004 re- 
port that all forms of yoga are becoming increasingly 
popular among Americans over 40 — particularly women 
and people living in urban areas — for general wellness as 
well as back pain or other specific health problems. At 
least 15 million adults in the United States have partici- 
pated in yoga programs, according to a study conducted 
at Harvard Medical School. Ninety percent of those con- 
tacted by telephone in a research sample said that they 
found yoga very or somewhat helpful. A survey of can- 
cer patients in a supportive care program at Stanford Uni- 
versity found that yoga and massage therapy were the 
activities that drew the largest number of participants. 

Training & certification 

There are no international or nationwide licensing or 
credentialing procedures for spiritual guides or teachers 
of bhakti yoga. The web site of the American Yoga Asso- 
ciation (AYA) does, however, include an article on “How 
to Choose a Qualified Teacher.” 



Dass, Ram. Journey of Awakening: A Meditator’s Guidebook . 
New York: Bantam Books, 1978. Contains some prayers, 
hymns, chants, and other suggestions for devotion drawn 
from Christian and Jewish sources that can be used in the 
practice of bhakti yoga. 

Dossey, Larry, MD. Healing Beyond the Body: Medicine and 
the Infinite Reach of the Mind . Boston: Shambhala Publi- 
cations, Inc., 2001. 

Feuerstein, Georg, and Stephan Bodian, eds. Living Yoga: A 
Comprehensive Guide for Daily Life, Part III, “Cultivating 
Love: Bhakti Yoga.” New York: Jeremy P. Tarcher/Perigee 
Books, 1993. 

Pelletier, Kenneth, MD> The Best Alternative Medicine, Chap- 
ter 2, “Sound Mind, Sound Body.” New York: Simon & 
Schuster, 2002. 

Sivananda, Swami, and the Staff of the Sivananda Vedanta 
Yoga Center. Yoga Mind and Body . New York: DK Pub- 
lishing, 1998. 


Rosenbaum, E., H. Gautier, P. Fobair, et al. “Cancer Supportive 
Care, Improving the Quality of Life for Cancer Patients. A 


Bhakti yoga 



Asanas — Physical postures associated with the 
practice of hatha yoga. 

Sanskrit — The classical literary language of India. 
It is considered the oldest living language of the 
Indo-Aryan family. 

Program Evaluation Report.” Supportive Care in Cancer 
12 (May 2004): 293-301. 

Saper. R. B., D. M. Eisenberg, R. B. Davis, et al. “Prevalence 
and Patterns of Adult Yoga Use in the United States: Re- 
sults of a National Survey.” Alternative Therapies in 
Health and Medicine 10 (March-April 2004): 44-49. 

Wolsko, P. M., D. M. Eisenberg. R. B. Davis, and R. S. 
Phillips. “Use of Mind-Body Medical Therapies.” Journal 
of General Internal Medicine 19 (January 2004): 43-50. 


American Yoga Association (AYA). P. O. Box 19986, Sarasota, 
FL 34276. (941) 927-4977. Fax: (941) 921-9844. <http://>. 

Yoga Alliance. 122 West Lancaster Avenue, Suite 204, Reading, 
PA 19607-1874. (610) 777-7793. Fax: (610) 777-0556. 

Yoga Research and Education Center (YREC). P. O. Box 426, 
Manton, CA 96059. (530) 474-5700. <http://www.yrec. 

OTHER Staff. “History of Bhakti Yoga.” [cited May 23, 2004]. 
<http : //w . 

Rebecca Frey, PhD 



Bilberry ( Vaccinium myrtillus ) is a European berry 
shrub that is related to the blueberry, huckleberry, and 
bearberry plants that grow in the United States. Bilberry 
is a small, wild, perennial shrub that grows throughout 
Europe and is now cultivated from the Far East to the 
United States. The shrub yields large amounts of small, 
darkish blue berries. Besides their medicinal use, they 
are often eaten fresh or made into jams and preserves. 
The leaves of the plant are used medicinally as well, but 
to a lesser extent than the berries. The qualities of the 
herb are sour, astringent, cold, and drying. 


Bilberry has been used by European herbalists for 
centuries. In Elizabethan times, bilberries were mixed 
with honey and made into a syrup called rob that was 
prescribed for diarrhea and stomach problems. The 
berries were also used for infections, scurvy, and kidney 
stones. The leaves of the plant were used as a folk reme- 
dy for diabetes. Bilberry is most famous, though, for its 
long use as a medicine for eye and vision problems. Leg- 
end has it that during World War II, British and Ameri- 
can pilots discovered that eating bilberry jam before 
night missions greatly improved their night vision. Bil- 
berries then became a staple for Air Force pilots. Since 
then, extensive research in Europe has shown that bilber- 
ries contain specific compounds that have beneficial ef- 
fects on the eyes and circulatory system. In France, bil- 
berries have been prescribed since 1945 for diabetic 
retinopathy, a major cause of blindness in diabetics. 

Bilberries are high in substances called flavonoids, 
which are found in many fruits, vegetables, grains, beans, 
peas, and are particularly abundant in citrus fruits and 
berries. Flavonoids are chemicals technically known as 
polyphenols. Flavonoids have antioxidant and disease- 
fighting properties. Antioxidants are substances that help 
cells in the body resist and repair damage. The flavonoids 
found in bilberry provide the blue color of the berry. The 
bilberry flavonoids are called anthocyano sides, which 
were found to be the main active ingredients. 

Bilberry flavonoids can increase certain enzymes 
and substances in the eyes that are crucial to good vision 
and eye function. Furthermore, anthocyanosides can in- 
crease circulation in the blood vessels in the eyes, and 
help these blood vessels repair and protect themselves. 
Specifically, research has shown that anthocyanosides 
help stabilize and protect a protein called collagen, 
which is a basic building block of veins, arteries, capil- 
laries, and connective tissue. Particularly, anthocyano- 
sides seem to work favorably in the tissues found in the 
retina, the back of the eye where major functions of vi- 
sion take place. The retina is composed of millions of 
tiny nerve cells and blood vessels, which anthocyano- 
sides can help support. Bilberry is a common treatment 
for many varieties of retinopathy, a disorder in which the 
intricate blood and nerve vessels in the retina are dam- 
aged. Retinopathy particularly affects people with dia- 
betes, high blood pressure, and sickle cell anemia. 

Many studies have documented bilberry’s useful- 
ness as a medicinal herb. One study demonstrated that 
bilberry extract used with Vitamin E prevented the pro- 
gression of cataracts in 48 of 50 patients with cataract 
formations. In animal studies, bilberry reduced and sta- 
bilized blood sugar levels. In an Italian study, bilberry’s 
flavonoids lowered cholesterol levels in the blood and 
improved circulation. 


General use 

Bilberry is most commonly used as a component of 
treatment for various vision and eye disorders, including 
glaucoma, cataracts, and macular degeneration. However, 
people with glaucoma should be monitored by an eye doctor 
regularly, and those with acute glaucoma should not depend 
on bilberry alone to protect their vision. They can use bilber- 
ry along with other emergency medical treatments. Bilberry 
is included in the treatments for many types of retinopathy 
and is also used for eye fatigue, poor night vision, and near- 
sightedness. It can be used as a preventative measure for 
glaucoma and cataracts, and to help those who require pre- 
cise night vision like cab drivers and pilots. Bilberry’s circu- 
lation improving and cholesterol lowering qualities make it 
useful in the treatment of varicose veins and atherosclero- 
sis. it is also occasionally prescribed for arthritis. 


Fresh bilberries can be eaten like blueberries, al- 
though they are difficult to find outside of Europe. Two 
to four ounce servings of the fresh fruit can be eaten 
three times a day. One to two cups each day is a good 
dose. Dried bilberries are sometimes available in herb or 
organic health food stores, and two or three small hand- 
fuls can be eaten per day. However, dried berries are 
likely to contain only a small amount of the flavonoids. 

Bilberry supplements are widely available in health 
food stores. They can be purchased as capsules and liq- 
uid extracts. A high-quality supplement may contain a 
standardized formula of up to 25% anthocyanocides. The 
dosage recommended with this percentage of active in- 
gredients is 80-160 mg taken three times daily. Bilberry 
supplements may be taken with food or on an empty 
stomach. Bilberry jam and syrup may also be used. 

For eye and circulatory problems, bilberry can be 
taken with ginkgo to increase its beneficial effects. Vita- 
mins A, C and E may also enhance bilberry’s healing ef- 
fects in the eye. Some suggestions have been made that 
other flavonoid-containing supplements, such as pine 
bark extract and grape seed extract, can possibly en- 
hance bilberry’s healing properties. 


Bilberry may be used as prevention and herbal sup- 
port for eye conditions, but should not replace medical 
care. Consumers with vision problems should be thor- 
oughly and immediately examined by an ophthalmologist 
(eye specialist) before any treatment or remedy is used. 

Side effects 

Bilberries can be taken in large doses without any 
side effects. However, bilberry leaves shouldn’t be taken 



Atherosclerosis — Disease in which the arteries 
and circulation are impaired from hardening and 
clogging, often from high cholesterol levels. 

Cataracts — Eye condition in which the lenses 
harden and lose their clarity. 

Glaucoma — Eye disease that can cause blindness; 
characterized by excess fluid between the iris and 
cornea of the eye. 

Macular degeneration — Disease in which the 
macula, the part of the retina responsible for pre- 
cise vision, deteriorates. 

in large doses or over long periods of time because they 

are toxic. 



Keville, Kathi. Herbs: An Illustrated Encyclopedia. New York: 
Friedman/Fairfax, 1994. 

Mayell, Mark. Off-the -Shelf Natural Health. New York: Ban- 
tam, 1995. 


HerbalGram (a quarterly journal of the American Botanical 
Council and Herb Research Foundation) RO. Box 144345, 
Austin, TX 78714-4345, (800) 373-7105. <http://www. . > 


Herb Research Foundation. 1007 Pearl Street, Boulder, CO 


Dietary Supplement Quality Initiative, <> 

Douglas Dupler 

Binge eating disorder 


Binge eating disorder (BED) is characterized by a 
loss of control over eating behaviors. The binge eater 
consumes unnaturally large amounts of food in a short 
time period, but unlike a bulimic, doesn’t regularly en- 
gage in any inappropriate weight-reducing behaviors 
(like excessive exercise, vomiting, taking laxatives) 
after the binge episodes. 


Binge eating disorder 

Binge eating disorder 


About three percent of women and one-tenth as 
many men have duffered from either bulimia or binge 
eating disorder at some time in their lives. BED typically 
strikes individuals between their adolescent years and 
their early 20s. Because of the nature of the disorder, 
most BED patients are overweight or obese. Studies of 
weight loss programs have shown that an average of 
30% of individuals enrolling in these programs report 
binge eating behavior. Binge eating in milder forms is 
even more common, as are attempts to compensate for 
the binges. 

Causes & symptoms 

Binge eating episodes may act as a psychological 
release for excessive emotional stress. Other circum- 
stances that may predispose an individual to BED in- 
clude heredity and mood disorders, such as major de- 
pression. BED patients are also more likely to have an 
additional diagnosis of impulsive behaviors (for exam- 
ple, compulsive shopping), post-traumatic stress disor- 
der (PTSD), panic disorder, or personality disorders. 
More than half also have a history of major depression. 
In 2002, the American Psychiatric Association was con- 
sidering including BED as a psychiatric diagnosis. 

individuals who develop BED often come from fam- 
ilies who put an unnatural emphasis on the importance of 
food. For example, these families may use food as a 
source of comfort in times of emotional distress. As chil- 
dren, BED patients may have been taught to clean their 
plates regardless of their appetite, or to be a good girl or 
boy and finish all of the meal. Cultural attitudes towards 
beauty and thinness may also be a factor in BED. 

During binge episodes, BED patients experience a 
definite sense of lost control over their eating. They eat 
quickly and to the point of discomfort, even if they aren’t 
hungry. They typically binge alone two or more times a 
week, and often feel depressed and guilty when the 
episode is over. 


BED is usually diagnosed and treated by a psychia- 
trist and/or a psychologist, in addition to an interview 
with the patient, personality and behavioral inventories, 
such as the Minnesota Multiphasic Personality Inventory 
(MMPI), may be administered as part of the assessment 
process. One of several clinical inventories, or scales, 
may also be used to assess depressive symptoms, includ- 
ing the Elamilton Depression Scale (HAM-D) or Beck 
Depression Inventory (BDI). These tests may be admin- 
istered in an outpatient or hospital setting. 



Many BED individuals binge after long periods of 
excessive dieting; therapy helps normalize this pattern. 
The initial goal of BED treatment is to teach the patient 
to gain control over his or her eating behavior by focus- 
ing on eating regular meals and avoiding snacking. Cog- 
nitive behavioral therapy, group therapy, or interper- 
sonal psychotherapy may be used to uncover the emo- 
tional motives, distorted thinking, and behavioral pat- 
terns behind the binge eating. The overweight BED 
patient may be placed on a moderate exercise program 
and a nutritionist may be consulted to educate the patient 
on healthy food choices and strategies for weight loss. 

Initial treatment may focus on curbing the depression 
that is a characteristic feature of BED. Recommended 
herbal remedies to ease the symptoms of depression may 
include damiana ( Turnera diffusa ), ginseng (Panax gin- 
seng), kola ( Cola nitida), lady’s slipper ( Cypripedium cal- 
ceolus), lavender ( Lavandula angustifolia), lime blossom 
(Tilia x vulgaris), oats ( Avena sativa), rosemary ( Rosmar- 
inus officinalis), skullcap ( Scutellaria laterifolia), St. 
John’s wort ( Hypericum perforatum), valerian ( Valeri- 
ana officinalis), and vervain ( Verbena officinalis). 

Binge-eating episodes that appear to be triggered by 
stress may be curbed by educating the patient in relaxation 
exercises and techniques, including aromatherapy, breath- 
ing exercises, biofeedback, music therapy, yoga, and mas- 
sage. Herbs known as adaptogens may also be prescribed by 
an herbalist or holistic healthcare professional. These herbs 
are thought to promote adaptability to stress, and include 
Siberian ginseng ( Eleutherococcus senticosus), ginseng 
( Panax ginseng), wild yam ( Dioscorea villosa), borage (Bor- 
ago officinalis), licorice ( Glycyrrhiza glabra), chamomile 
0 Chamaemelum nobile), and nettles ( Urtica dioica). Tonics 
of skullcap ( Scutellaria lateriafolia), and oats ( Avena sativa), 
may also be recommended to ease anxiety. 

Allopathic treatment 

Treatment with antidepressants may be prescribed 
for BED patients. Selective serotonin reuptake inhibitors 
(such as Prozac) are usually preferred because they offer 
fewer side effects. However, clinical studies don’t show 
much effectiveness for use of antidepressants in treating 
BED. Psychotherapy shows better results. Once the 
binge eating behavior is curbed and depressive symp- 
toms are controlled, the physical symptoms of the disor- 
der can be addressed. 

Expected results 

The poor dietary habits and obesity that are sympto- 
matic of BED can lead to serious health problems, such as 



Bulimia — An eating disorder characterized by 
binge eating and then excessive behavior (such as 
vomiting, misusing laxatives, or exercising exces- 
sively) to rid the body of the food eaten. 

Cognitive behavioral therapy — A therapy that fo- 
cuses on changing negative behavior in order to 
alter the attitudes or harmful thinking patterns that 
cause the behavior. 

high blood pressure, heart attacks, and diabetes, if left 
unchecked. BED is a chronic condition that requires ongo- 
ing medical and psychological management. To bring 
long-term relief to the BED patient, it is critical to address 
the underlying psychological causes behind binge eating 
behaviors. It appears that up to 50% of BED patients will 
stop bingeing with cognitive behavioral therapy. 



Abraham, Suzanne and Derek Llewellyn-Jones. Eating Disor- 
ders: The Facts. 4th ed. Oxford: Oxford University Press, 

American Psychiatric Association. Diagnostic and Statistical 
Manual of Mental Disorders, 4th ed. Washington, DC: 
American Psychiatric Press, Inc., 1994. 

Siegel, Michele, Judith Brisman, and Margot Weinshel. Surviv- 
ing an Eating Disorder: Strategies for Family and 
Friends, 2nd ed. New York: Harper Perennial, 1997. 


Brewerton, Timothy D. “Binge Eating Disorder: Recognition, 
Diagnosis, and Treatment.” Medscape Mental Health 2, 
no. 5 (1997). 

"Treatment of Bulimia and Binge Eating.” Harvard Mental 
Health Letter (July 2002). 

Tufts University. "Binge Eating Disorder Comes Out of the 
Closet: Experts Say Leading Obesity Factor Has Long 
Been Overlooked.” Tufts University Diet & Nutrition Let- 
ter 14, no. 1 1 (January 1997): 4-5. 


American Psychiatric Association ( APA). Office of Public Af- 
fairs. 1400 K Street NW, Washington, DC 20005. (202) 

American Psychological Association (APA). Office of Public 
Affairs. 750 First St. NE, Washington, DC 20002-4242. 
(202) 336-5700. 

Eating Disorders Awareness and Prevention. 603 Stewart St., 
Suite 803, Seattle, WA 98101. (800) 931-2237. http:// 

National Eating Disorders Organization (NEDO). 6655 South 
Yale Ave., Tulsa, OK 74136. (918) 481-4044. 


Overeaters Anonymous World Service Office. 6075 Zenith Ct. 
NE, Rio Rancho, NM 87124. (505) 891-2664. http://www. 

Paula Ford-Martin 
Teresa G. Odle 

Biocytin see Brewer's yeast 



Biofeedback, or applied psychophysiological feed- 
back, is a patient-guided treatment that teaches an individ- 
ual to control muscle tension, pain, body temperature, brain 
waves, and other bodily functions and processes through 
relaxation, visualization, and other cognitive control tech- 
niques. The name biofeedback refers to the biological sig- 
nals that are fed back, or returned, to the patient in order for 
the patient to develop techniques of manipulating them. 


In 1961, Neal Miller, an experimental psychologist, 
suggested that autonomic nervous system responses (for in- 
stance, heart rate, blood pressure, gastrointestinal activity, 
regional blood flow) could be under voluntary control. As a 
result of his experiments, he showed that such autonomic 
processes were controllable. This work led to the creation 
of biofeedback therapy. Willer’s work was expanded by 
other researchers. Thereafter, research performed in the 
1970s by UCLA researcher Dr. Barry Sterman established 
that both cats and monkeys could be trained to control their 
brain wave patterns. Sterman then used his research tech- 
niques on human patients with epilepsy, where he was able 
to reduce seizures by 60% with the use of biofeedback tech- 
niques. Throughout the 1970s, other researchers published 
reports of their use of biofeedback in the treatment of car- 
diac arrhythmias, headaches, Raynaud’s syndrome, and 
excess stomach acid, and as a tool for teaching deep relax- 
ation. Since the early work of Miller and Sterman, biofeed- 
back has developed into a front-line behavioral treatment 
for an even wider range of disorders and symptoms. 


Biofeedback has been used to successfully treat a 
number of disorders and their symptoms, including tem- 
promandibular joint disorder (TMJ), chronic pain, irrita- 
ble bowel syndrome (IBS), Raynaud’s syndrome, 
epilepsy, attention-deficit hyperactivity disorder 




A patient undergoing biofeedback therapy. (Photo Re- 
searchers, Inc. Reproduced by permission.) 

(ADHD), migraine headaches, anxiety, depression, 
traumatic brain injury, and sleep disorders. 

Illnesses that may be triggered at least in part by 
stress are also targeted by biofeedback therapy. Certain 
types of headaches, high blood pressure, bruxism (teeth 
grinding), post-traumatic stress disorder, eating disor- 
ders, substance abuse, and some anxiety disorders may 
be treated successfully by teaching patients the ability to 
relax and release both muscle and mental tension. 
Biofeedback is often just one part of a comprehensive 
treatment program for some of these disorders. 

NASA has used biofeedback techniques to treat astro-